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Grand Rounds - June 5, 2020
"Antiviral Treatment Update"

Speaker: Rajendra Kapila, MD

 

 

Objectives:

  1. Describe the indication for the use of antiviral medications
  2. Evaluate the use of antiviral medications for the treatment of HIV
  3. Evaluate the use of antiviral medications for herpes, hepatitis and influenza
  4. Understand the current investigation into the use of antiviral medications for COVID-19

Accreditation: St. Charles Health System is accredited by the Oregon Medical Association 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.

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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Jefferson County students honored with scholarships to pursue health care careers

BEND, Ore. – St. Charles Health System, St. Charles Foundation and Cascades East Area Health Education Center (AHEC) have awarded scholarships to 12 college students and high school seniors from Jefferson County who are pursuing careers in health care.

Awards are based on students’ grade point averages and activities, but the most compelling factor is their commitment to returning to a rural location upon completion of their education. Several of the students have participated in St. Charles’ job shadowing program and credit it with inspiring them to pursue a health care career. 

“In this difficult time, it is more important than ever to recognize the efforts and commitment of these students to pursue a career in health care,” said Cascades East AHEC Director Debbie Cole. “We look forward to their returning to Central Oregon as valuable partners in our community’s health.” 

College students awarded a scholarship include: 

  • Jordan Gemelas, a fourth-year medical student at OHSU, who will receive $4,000 from Cascades East AHEC
  • Catylynn Duff, a third-year student and track athlete at the College of Idaho, who will receive $3,000 from the St. Charles Foundation-Jefferson County fund
  • Kaliyah Iverson, a student at Portland State University, who will receive $1,000 from Cascades East AHEC

Culver High School students awarded a scholarship include:

  • Felicia Belvoir, who will receive $1,000 from the St. Charles Foundation-Jefferson County fund 
  • Johan Jaimes, who will receive $1,000 from the Redmond Medical Staff 
  • Janae Rhen, who will receive $500 from Cascades East AHEC 
  • Karyssa Pettersen, who will receive the $2,000 Mary Ann Thomas Hosier scholarship for nursing 

Madras High School students awarded a scholarship include:

  • Kelly Huang, who will receive $2,000 from the St. Charles Foundation-Jefferson County fund
  • Kelsey Olivera, who will receive $2,000 from Cascades East AHEC
  • Brianna Carvajal and Elizabeth Egoavil, who will each receive $1,500 from the St. Charles Foundation-Jefferson County fund; Egoavil will also receive $500 from Cascades East AHEC
  • Treyvon Easterling will receive $1,000 from the St. Charles Foundation-Jefferson County fund

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 and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,200 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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Klamath County students honored with scholarships to pursue health care careers

BEND, Ore. – St. Charles Health System and Cascades East Area Health Education Center (AHEC) have awarded scholarships to two high school seniors from Klamath County who are pursuing careers in health care.

Awards are based on students’ grade point averages and activities, but the most compelling factor is their commitment to returning to a rural location upon completion of their education. Several of the students have participated in St. Charles’ job shadowing program and credit it with inspiring them to pursue a health care career.

“In this difficult time, it is more important than ever to recognize the efforts and commitment of these students to pursue a career in health care,” said Cascades East AHEC Director Debbie Cole. “We look forward to their returning to Central Oregon as valuable partners in our community’s health.”

Scholarship winners include:

  • Larken Ackley from Gilchrist High School, who will receive a $1,000 Cascades East AHEC scholarship
  • Yulisa Alonzo from Lost River High School, who will receive a $2,000 Mary Ann Thomas Hosier scholarship to pursue her dream of becoming a nurse

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 and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,200 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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Deschutes County students honored with scholarships to pursue health care careers

BEND, Ore. – St. Charles Health System and Cascades East Area Health Education Center (AHEC) have awarded scholarships to seven high school seniors and college students from Deschutes County who are pursuing careers in health care.

Awards are based on students’ grade point averages and activities, but the most compelling factor is their commitment to returning to a rural location upon completion of their education. Several of the students have participated in St. Charles’ job shadowing program and credit it with inspiring them to pursue a health care career. 

“In this difficult time, it is more important than ever to recognize the efforts and commitment of these students to pursue a career in health care,” said Cascades East AHEC Director Debbie Cole. “We look forward to their returning to Central Oregon as valuable partners in our community’s health.” 

Scholarship winners include:

  • Bend High School students Eleni Edwards and Rachel Hanson, who will each receive $500 from Cascades East AHEC
  • Mountain View High School students Titus Schulz, McKenna Smith and Marli Von Heideken, who will each be awarded $1,000 from Cascades East AHEC
  • Redmond High School student Brooklyn Thompson and Central Christian School student Eren Wynne, who will each receive $500 from the Redmond Medical Staff

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 and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,200 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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Crook County students honored with scholarships to pursue health care careers

BEND, Ore. – St. Charles Health System and Cascades East Area Health Education Center (AHEC) have awarded scholarships to 10 high school seniors and college students from Crook County who are pursuing careers in health care.

Awards are based on students’ grade point averages and activities, but the most compelling factor is their commitment to returning to a rural location upon completion of their education. Several of the students have participated in St. Charles’ job shadowing program and credit it with inspiring them to pursue a health care career. 

“In this difficult time, it is more important than ever to recognize the efforts and commitment of these students to pursue a career in health care,” said Cascades East AHEC Director Debbie Cole. “We look forward to their returning to Central Oregon as valuable partners in our community’s health.” 

Crook County High school students awarded a $1,000 scholarship from Cascades East AHEC include:

  • Lily Cooper
  • Rebecca Cooper
  • Kara Hurt
  • Jillian Nguyen
  • Carmen Parmelee
  • Miranda Vargas
  • Patsy Wagner 

College students awarded a scholarship include:

  • Shane Kessi and Gwyneth Ptomey, who are each receiving a scholarship from the Mary Ann Thomas Hosier endowment. This scholarship is awarded to exceptional students pursuing a career in nursing
  • Esmerelda Ortiz Ventura, who will receive $1,000 from Cascades East AHEC to continue her studies in radiology at Oregon Institute of Technology

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 and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,200 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 - May 29, 2020
“Medical Conspiracy Theories and Covid-19"

Speaker: Joseph Pierre, MD

Objectives:

  1. Identify how common it is to believe at least one medically-related conspiracy theory.
  2. Describe at least one conspiracy theory related to COVID-19.
  3. Describe how mistrust and misinformation can lead to belief in medical conspiracy theories.
  4. List one strategy to decrease belief in medical conspiracy theories.
  5. Define the role that cultural diversities (gender, age, race, religion, ethnicity, language, sexual orientation, socio-economics, etc.) may play in medical conspiracy theories

Accreditation: St. Charles Health System is accredited by the Oregon Medical Association 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.

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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Over the past couple of weeks, I’ve been thinking a lot about how fortunate we are here at St. Charles that even during these difficult times, local companies and individuals have stepped up to support us throughout this pandemic.

In addition to donations of personal protective equipment, gifts to our Hero Fund and notes of appreciation and encouragement, we have received so many deliveries of food, drinks, self-care items and more to help our caregivers during this stressful time. I can assure you these donated items were greatly appreciated. They have helped our people care for this community, and they will continue to do so as we navigate the next several months.

With many Central Oregon businesses starting to reopen, it’s time for all of us to think about how we can give back. We know that restaurants and retailers are suffering from the severe economic impact of COVID-19. Last week, I emailed our army of 4,500 caregivers and urged them to go out and support them as they have supported us. And I hope you’ll recognize that by supporting us, those restaurants and retailers were supporting you – our community. Please join us in returning the favor.

Here are just a few ideas on how you can help:

  • The list of businesses that have donated to St. Charles over the past couple of months is very long, and if we tried to compile one, we run the risk of leaving some out. So instead, I simply want to encourage you to pick a local company to support – safely, while wearing a mask – by buying something you need or ordering a take-out dinner. When you do, snap a photo and post it to social media with a note of gratitude. (Please be sure to tag @STChealth so we can “like” it.)
  • Visit SOS Bend and purchase gift cards to a business of your choice.
  • Buy a T-shirt from the Here for Good - Oregon effort of a local screen printer in Sisters, where proceeds also go to support local businesses of your choice.
  • Visit Central Oregon SOS for other resources and information on how to help.

In addition to these ideas, St. Charles as an organization is sharing information with our local health departments on how to reopen businesses safely. We are working with those same departments to provide additional staff resources and assist with contact tracing throughout the region. And now that our stockpile of PPE is more robust, we have been able to donate excess supplies to our community partners in need through the tri-county emergency operations center.

Thank you in advance for helping us show businesses across Central Oregon how much St. Charles cares about rebuilding a vibrant, thriving local economy. They have had our backs through this crisis. Rest assured, we will have theirs for as long as it takes.

One last thing: This coming weekend, May 30-31, Oregon State University will bring a COVID-19 research project called TRACE to Bend. With support from Deschutes County Health Services, the TRACE team will visit 30 Bend neighborhoods to conduct random, door-to-door COVID-19 testing. Note: The swabs used for these tests collect material from inside the entrance of the nose and are less invasive than those that collect secretions from the throat and the back of the nose.

Results from the project will help us understand how prevalent the virus is in Bend, and at this point, everything we can learn about COVID-19 is absolutely vital. So if you get a knock on your door Saturday or Sunday, I want to encourage you to please consider participating in the project. You can learn more about TRACE here.

Sincerely,
Joe

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For Jeri Young, St. Charles Health System’s child life specialist, every day brings a new set of patients, families, tasks and challenges.

Generally speaking, Young’s job is to help kids cope with medical care through play, self-expression activities and age-appropriate education. In a given day, that could include using rain sticks to distract a toddler from a needle poke, educating a dying parent on how to talk to their kid about end-of-life, developing child-focused hospital policies, or sitting on the floor for an hour, playing Legos with a young patient.

Young learned long ago that the only predictable part of her job is its unpredictability.

“My favorite question is, ‘What does a typical day look like?’ and my answer is, ‘You write out your schedule for the day and then you tear it up and throw it away. And off you go,’” she said.

Young came to Central Oregon in the spring of 2019 after 37 years experience working as a child life specialist at Children’s Hospital Colorado in Colorado Springs, as well as Shriners Hospitals for Children and Doernbecher Children’s Hospital in Portland. She is St. Charles’ first child life specialist.

Funded by more than $140,000 raised by the St. Charles Foundation, the system’s child life specialist program was created to help young patients and their families adjust and cope with hospital or clinic settings, illness or injury and the treatments involved. Because children process information much differently from adults, they have distinct needs for managing the effects of stress and trauma.

“The hospital is scary for anybody, so trying to make it a little less scary for kids is our goal. I explain the things that are going to happen to them and the role they’re going to play. We talk through the procedure before it’s performed or even while it’s being performed,” Young said. “We play, because what do kids do? They don’t sit in a bed and watch TV with their parents sitting nearby. They play. So ultimately, we’re trying to normalize the situation for the kiddos and we want to help them build support and skill systems for themselves.”

In her first year at St. Charles, Young helped more than 1,300 patients in the pediatric inpatient unit, the Emergency Department, the Intensive Care Unit and the pre-op and radiology departments, said Randa Bates, nurse manager for Neonatal Intensive Care and Pediatric Services. More specifically, Young has helped many pediatric patients undergo an MRI without sedation, which lowers their risk and shortens their stay at the hospital, Bates said.

Additionally, Young has revamped multiple hospital policies to be more child-friendly, she started a volunteer program to support the pediatric unit, and she is part of a workgroup that’s designing the hospital’s pediatric treatment room, Bates said.

“There’s just a ton of work that Jeri has done around here, and she has built so many of these things from the ground up,” she said. “It’s pretty amazing to step back and take a look at the impact.”

With help from schedulers and nurses, Young sometimes knows what’s coming her way in a given day. But with word spreading about her services, she also has to remain agile enough to respond to emergent needs and unplanned calls for help.

“I arrived this morning to a lovely sticky note that said, ‘I have a child downstairs. Would you go see them and support them?’” she said. “The longer I’m here, the more those kinds of things are coming through. It just takes boots on the ground and continuing to say, ‘I’m here. How can I help?’”

Elizabeth Oshel’s family found their way to Young via referral from daughter Piper’s primary care physician. When the doctor sent Piper to the hospital for a procedure, he specifically told Oshel to seek out the child life specialist.

“He was the one who said it’s important that we have this resource available to us,” said Oshel, who lives in Bend. “He said, ‘When you call and schedule, make sure you tell them that I want the child life specialist there for her.’”

When the family arrived at St. Charles Bend, Young was waiting in the lobby, Oshel said, and immediately started working to entertain Piper, 7, and to ease her mind. Once the two had a rapport, Oshel said, Young began asking the girl if she had questions or worries, or if she wanted any information.

“Jeri was able to normalize the things Piper was worried about and she reassured her that it was OK to be worried and that she’d get answers for her,” Oshel said. “It was incredible to see how Piper’s demeanor changed once she knew Jeri was in her corner.”

Young waited for Piper to come out of her procedure and reassured her. When a follow-up procedure was scheduled, she set up a day-before tour of the room for the family. All along the family’s journey at St. Charles Bend, Young “stayed one step ahead of us” in terms of logistics — in addition to helping Piper overcome her anxiety.

Looking back, Oshel believes Young’s role is essential to the hospital’s pediatric programming.

“I don’t see how you can provide those kinds of services for kids without the services of a child life specialist on staff,” she said. “It was absolutely amazing to have someone there who was focused on the patient and their well-being, not just the medical aspect of their care.”

Of course, Young is just one person, and by nature, she is the type who believes there’s always room for improvement. So while she can’t get to every child in the hospital who needs support, she continues to work with other caregivers to try to catch as many as she can. In the meantime, the hospital has a second child life specialist, Kyle Calhoon, set to join the team on June 15, Bates said.

She couldn’t be more excited, because she knows what a difference the program has made at St. Charles.

“We used to hear stories from families about kids throwing a fit while going into surgery, and rightfully so — they’re scared,” Bates said. “We don’t hear nearly as many of those stories anymore, and that’s a testament to Jeri’s work, to the Foundation’s support for this program, and to the doctors, nurses and others who are calling her in to help in those situations. It truly is a team effort, and the kids and their families are the ones who benefit.”

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Physicians who treated Central Oregon’s first COVID-19 patient to receive a transfusion of convalescent plasma cannot say with certainty how much the blood product helped 53-year-old Liliana Locke, who is now recovering at home.

But anecdotal results and early findings by the Mayo Clinic, which is coordinating the national expanded access protocol used to provide the plasma, are positive enough to encourage recovered COVID-19 patients to consider a donation, said Dr. Anna Dolezal, a pathologist with Central Oregon Pathology Consultants and acting medical director of the St. Charles Blood Bank.

“Among the first 5,000 patients who received convalescent plasma through that program, the incidence of serious adverse events was very low,” Dolezal said. “So what we can take from that is that infusing COVID-19 patients with convalescent plasma appears to be a safe procedure, and this initiative will continue nationally.”
In fact, the American Red Cross recently expanded its criteria for who can donate convalescent plasma. Until late April, donors must have tested positive for COVID-19 and fully recovered. (People who have fully recovered from the virus have antibodies in their plasma that can attack the virus and may help people fight the disease.) On April 27, however, the Red Cross began allowing people who don’t have a positive test but are certain they had COVID-19 to donate plasma. Those donations are tested for antibodies, allowing the Red Cross to simplify the eligibility process and qualify more potential donors.

Earlier data available from studies indicated that a single 200 mL dose of convalescent plasma showed benefit for some patients, leading to improvement. And while the Mayo Clinic’s program isn’t a randomized clinical trial and is designed primarily to ensure safety, data from the first 5,000 patients enrolled in the protocol did show some promising results and also noted "with optimism the relatively low mortality in treated patients." This included a trend toward decreased mortality at seven days (14.9%) compared to average mortality for patients with COVID-19 in the hospital (15-20%) and ICU (57%).

Dolezal emphasized: “While there is still much work to be done to tease out the true efficacy of this treatment – as is true at this time with all treatments being explored for COVID-19 – the initial report from Mayo looks promising to me. If we can make convalescent plasma available to more COVID patients earlier in their hospital course, I’m hopeful that it can make a potentially life-saving difference in their outcome.”

Use of convalescent plasma has been studied in outbreaks of other respiratory infections, including the 2003 SARS-CoV-1 epidemic, the 2009-2010 H1N1 influenza virus pandemic and the 2012 MERS-CoV epidemic, according to the FDA.

Given the severity of the pandemic and lack of other available treatments for COVID-19, the U.S. Food and Drug Administration approved its use as an investigational new drug in late March. Since that time, blood suppliers have been working tirelessly to increase the pool of available plasma.

To schedule an appointment to donate COVID-19 convalescent plasma or other blood products, contact American Red Cross Blood Services at 1-800-RED-CROSS or https://www.redcrossblood.org/. More information can be found at the following links:

Eligibility requirements and a donor eligibility form

Frequently asked questions, including sections on COVID-19 and donating convalescent plasma.

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