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2012 Grand Rounds Archive

December 14, 2012 - "Five Fundamentals of Patient Communication: Tools to Improve Clinical Outcomes and Increase Patient Satisfaction"
Speaker: Joshua C. Cook, DO, Medical Director, Emergency Department, Pioneer Memorial Hospital

Objectives: 1) Discuss the impact of patient satisfaction surveys (HCAHPS) on hospital reimbursement (beginning January 2013), and future reimbursement in the outpatient setting. 2) Describe evidence-based methods designed to improve the patient's experience in terms of patient satisfaction, clinical outcomes, patient compliance, and efficient care delivery in both the inpatient and outpatient settings. 3) Using the AIDET model, demonstrate the five fundamentals of patient communication (Acknowledge, Introduce, Duration, Explanation, Thank you), and other experience-enhancing behaviors. 4) List both negative and positive behaviors that impact the patient's perception of the care they receive.

Handouts: Handout PDF, Additional Handout PDF

December 07, 2012 - "Annual Update in Outpatient Medicine"
Speaker: Robert A Gluckman, MD, FACP, Internal medicine specialist; Chief Medical Officer, Providence Health Plans

Objectives: 1) Using results from recent studies, discuss current evidence relevant to outpatient internal medicine. Topic areas include updates on cancer, abdominal aortic aneurysm, surveillance stress testing in coronary disease, and potential over treatment if hypertension in diabetes. Final content will depend upon recent publications.

Handouts: Handout PDF

November 30, 2012 - "Antibiotic Stewardship in the Healthcare Setting"
Speaker: Thomas Ward, MD, Asso. Professor, Division of Infectious Disease, Oregon Health & Science University

Objectives: 1) Identify patients at risk for bloodstream infections and multiple drug-resistant pathogens. 2) Describe features of interventions that have been successful in reducing inappropriate use of antibiotics, including outpatient management.

Handouts: Handout PDF

November 16, 2012 - "Surgical Lessons Learned During the War on Terror"
Speaker: Richard Mullins, MD, Professor of Surgery, Section of Trauma/Critical Care, OHSU; Captain, Inactive Ready Reserve, United States Naval Reserve (recently deployed to Afghanistan)

Objectives: 1) Discuss key concepts of far forward casualty care in the military, including the mobile field surgical team. 2) Identify key differences between urban trauma care and combat trauma care. 3) Discuss how military experience may be applied in the civilian patient population.

Handouts: Handout PDF

November 09, 2012 - "The Business of Medicine: What Physicians Need to Know and Do to Be Regarded as Best Practice Performers"
Speaker: Alan H. Rosenstein, MD, MBA, Medical Consultant, Health Care Management; Medical Director, Physician Wellness Services; Medical Director, Clinical Efficiency and Care Management at ValleyCare Hospital, Pleasanton, CA

Objectives: 1) Discuss the impact of health care reform on reimbursement in both the hospital and outpatient setting. 2) Discuss principles and objectives of effective case management programs. 3) Discuss implications of coding and documentation on reimbursement and quality ratings. 4) Discuss implications of provider accountability and physician performance profiles. 5) Discuss strategies of improving physician engagement and compliance in adhering to best practice standards of care.

November 02, 2012 - "2012 Update on Infective Endocarditis"
Speaker: Arnold Bayer, MD, FACP, FCCP, FIDSA, Professor of Medicine — UCLA School of Medicine; Associate Program Director, Infectious Disease, Harbor-UCLA Medical Center

Objectives: 1) Review the changes in the demographics of infective endocarditis (IE), from an infection of patients with underlying valvular heart disease to a syndrome of modern medical devices and progress. 2) Discuss new approaches to the diagnosis of IE by echocardiography. 3) Describe new treatment paradigms including non-antibiotic approaches. 4) Review recent AHA changes in IE prophylactic strategies for dentists and other medical professionals.

October 19, 2012 - "Emerging Treatment Paradigms in Heart Valve Disease"
Speaker: Saurabh Gupta, MD, FACC, FSCAI, Director, Cardiac Catheterization Laboratories; Co-Director, Multi-Disciplinary HeartValve Clinic; Associate Program Director, Interventional Cardiology Fellowship; Oregon Health & Science University

Objectives: 1) Recognize components and steps to set up a multi-disciplinary Heart Valve Clinic. 2) Learn about surgical and catheter based options and timing for correction of mitral regurgitation and mitral stenosis. 3) Recognize and identify patients with significant aortic valve disease. 4) Discuss results of surgical aortic valve replacement (AVR) and trans-catheter aortic valve replacement (TAVR) and triage to medical management, AVR or TAVR.

Handouts: Handout PDF

October 12, 2012 - "Evidence-based Strategies for Treatment-Resistant Depression in Geriatric Patient"
Speaker: Clifford Singer, MD, Clinical Associate Professor, Psychiatry, University of Vermont; Practice in Geriatric Neuropsychiatry and Nursing Homes

Objectives: 1) Discuss evidence-based strategies for treatment resistant depression in late life. 2) Discuss strategies for therapeutic augmentation, taking into account co-morbidities.

Handouts: Handout PDF

October 05, 2012 - "Best Practices for Two Physician Holds and Consent to Treatment: A Panel Discussion"
Moderator: Magnus Lakovics, MD, Psychiatrist, Bend Psychiatric Associates Jennifer Laughlin, DO, Hospitalist, St. Charles Hospital Medicine — Bend Gary Bruce, General Counsel and Director of Compliance, St. Charles Health System Randall Hanson-McBride, RN-BC, Psychiatric Emergency Services, St. Charles Bend John E. Laherty, Deschutes County Assistance Legal Counsel

Objectives: Using case presentations and Q&A format, a panel will address the dilemmas, legal process and best practice for two-physician holds and consent to treatment. Practitioners will gain tools enabling them to address questions such as:

  • When and how is it appropriate to place a patient in a "two-physician hold?"
  • When is it appropriate to intervene if an inpatient with a medical condition refuses care?
  • What is the appropriate response to a volatile or self-injurious patient in the outpatient setting?
  • What are the practitioner's legal rights in the hospital and outpatient setting, and how does hospital Risk Management support physicians in their decision making?
  • What is the role of the nursing staff?

Handouts: Handout PDF

September 28, 2012 - "Integrating Behavioral Health and Primary Care"
Note: Video has 1 minute of lag time and then intro ends at 3:48.

Speaker: Benjamin F. Miller, PsyD, Assistant Professor, Department of Family Medicine, Associate Director of Primary Care Outreach and Research, Univ of Colorado Depression Center, Univ of Colorado School of Medicine, Aurora, CO

Objectives: 1) Explain the evidence supporting the use of behavioral health providers and interventions in primary care, and how integrated care supports successful health outcomes for patients. 2) Articulate the characteristics of three interventions and how they differ from traditional specialty behavioral health approaches. 3) Understand how to support implementation of brief therapy models and applicability in a variety of practice settings.

Handouts: Handout PDF

September 21, 2012 - "And Then They Came Home: Improving Behavioral Health Outcomes for Returning Veterans"
Speaker: Morgan Sammons, PhD, ABPP, Professor, Department of Clinical Psychopharmacology; Dean, California School of Professional Psychology, San Francisco, Alliant International University

Objectives: 1) Discuss the extent of mental health issues in service members returning from combat. 2) Explain the importance of knowing about military culture and the military hierarchy. 3) List the reasons for asking patients about their military service or the military service of close family members. 4) List the populations served by the Dept. Veterans Affairs. 5) Restate signs and symptoms of PTSD and TBI. 6) Identify barriers to treatment and opportunities to improve care delivery.

Handouts: Handout PDF

September 14, 2012 - "Type II Diabetes Might Be a Surgical Disease"
Speaker: Stephen Archer, MD, Advanced Specialty Care

Objectives: 1) Review recent randomized trials comparing medical and surgical therapy for Type II Diabetes. 2) Explain current understanding of the physiology of resolution of diabetes after metabolic surgery. 3) Review the physiology of satiety, weight loss and brain signaling after metabolic surgery. 4) Suggest guidelines for surgical therapy of diabetes.

Handouts: Handout PDF

September 07, 2012 - "Palliative Care 2012: Matching Care to Our Patients' Needs"
Speaker: Diane E. Meier, MD, Director, Center to Advance Palliative Care, Mount Sinai School of Medicine and National Program Office of the Robert Wood Johnson Foundation; Professor, Departments of Geriatrics and Medicine, Mount Sinai School of Medicine

Objectives: 1) Assure accurate understanding of palliative care and its distinction from hospice. 2) Be familiar with outcomes data from palliative care studies demonstrating improved quality of life, length of life, and reduced hospital costs. 3) Understand the meaning of the "value equation" in healthcare. 4) Link improvement of the value equation (quality/cost) to improved access to palliative care.

Handouts: Handout PDF

July 20, 2012 - July 20, 2012 — "Meniere's Disease: A Better Understanding"
Speaker: John Renton, MD, Otolaryngology, Central Oregon ENT

Objectives: 1) Discuss the clinical manifestations of Meniere's disease. 2) Identify guidelines for appropriate diagnosis and treatment.

Handouts: Handout PDF

July 13, 2012 - "Integrating the Clinical Pharmacist in Team-based Approaches to Care"
Speaker: Jennifer Tryon, PharmD, MS, Assistant Director of Pharmacy; Pharmacy Residency Program Director

Objectives: 1) Discuss efforts to improve quality of care by integrating clinical pharmacy services into the care and management of high risk, high-cost, complex patients. 2) Describe pharmacy models of care and explain the strengths and limitations of the clinical pharmacist.

Handouts: Handout PDF

June 29, 2012 - "Current (and Future) Guidelines for Evaluation and Treatment of Hypercholesterolemia"
Note: The presentation begins at 1:40 Please skip ahead to bypass chatter.

Speaker: Michael Shapiro, DO, Assistant Professor of Medicine, Cardiovascular Medicine, Oregon Health & Science University

Objectives: 1) Review current national guidelines for evaluation and management of hypercholesterolemia. 2) Discuss predicted changes to future guidelines. 3) Examine FDA safety label changes for statins, including the suggested link between statin use and risk of diabetes.

Handouts: Handout PDF, Flyer PDF

June 15, 2012 - "Sedation and Delirium in Critically Ill Patients"
Speaker: Russell R. Miller, III, MD, MPH, Pulmonary and Critical Care, Intermountain Healthcare, Utah

Objectives: 1) Recognize indications for sedation; 2) Discuss importance of monitoring delirium; 3) Review best practice for sedation and delirium in the ICU.

Handouts: Handout PDF

June 08, 2012 - "The Psychology of Medical Providers: Aspiration for Excellence or Self-Destruction?"

Speaker: Mick Oreskovich, MD, Clinical Professor of Psychiatry, University of Washington. Board certified general and addiction psychiatrist, and general surgeon, and former medical director and CEO of the Washington Physicians Health Program.

Objectives: 1) Explore the role of perfectionism and self-recrimination as precursors to burnout, depression, substance abuse and suicide. 2) Describe how current stressors in the culture and practice of medicine combine with specific psychological characteristics of medical providers to become threats to survival. 3) Explore the origins of perfectionism and shame and introduce a paradigm for avoiding the "perfect storm."

Handouts: Handout PDF

June 01, 2012 - "Epidemic of Vitamin D Deficiency: Fact of Fiction?"
Speaker: Neil Buist, MD, FRCPE, Emeritus Professor of Pediatrics and Molecular & Medical Genetics, OHSU

Objectives: 1) Discuss the basic relationships between Vitamin D, PTH, calcium and phosphorus. 2) Describe the manifestations of D deficiency in children and differential diagnosis of rickets. 3) Discuss the current controversy on D levels and adult onset disorders. 4) Discuss the indications for assay of plasma D levels and the normal range.

Handouts: Flyer PDF, Handout PDF: Epidemic of Vitamin D, Handout PDF: Low 25-Hydroxy Vitamin D Levels, Handout PDF: Vitamine D Intakes

May 18, 2012 - "Getting Away from Sliding Scale Insulin: A system-based approach to improve patient outcomes in the inpatient setting"
Speaker: Andrew Ahmann, MD, Professor of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, OHSU; Director: Harold Schnitzer Diabetes Health Center

Objectives: 1) Using a series of case studies, discuss how the literature supports targeted glucose control in the hospital setting for potential improved clinical outcomes. 2) Engage in developing a system-wide awareness that challenges popular prescribing patterns. 3) Employ tools to develop an algorithm for inpatient management of insulin.

Handouts: Handout PDF, Handout PDF 2

May 04, 2012 - "Examining the Reliability of Published Research Findings"
Speaker: Roger Chou, MD, Associate Professor, Departments of Medicine and Medical Informatics & Clinical Epidemiology at OHSU; Scientific Director, Oregon Evidence-based Practice Center, funded by the Agency for Healthcare Research and Quality; Staff Physician in the Internal Medicine Clinic at OHSU.

Objectives: 1) Discuss the sources of bias in research studies and how they affect results and conclusions. 2) Describe how to critically appraise research studies and when findings can be applied to clinical practice. 3) Learn when to trust and use systematic reviews and guidelines.

Handouts: Handout PDF

April 27, 2012 - "The Healthcare Response to Disaster: The Joplin Story"
Speaker: Skip Harper, CSP, CEM, Environmental, Health and Safety Officer and Emergency Preparedness Coordinator for Freeman Health System in Joplin, Missouri. Skip was the original incident commander following the Joplin tornado, and served in several capacities during the response and recovery. Skip is the liaison with all local, state and federal authorities involving preparedness and response efforts for the health system.

Objectives: 1) Describe the many facets of Joplin's response to the disaster, such as communications, first responders, search and rescue, shelters, and the care provided during the event and follow up medical care. 2) Enhance medical staff and hospital's preparedness in a disaster event.

Handouts: Handout PDF

April 20, 2012 - "Examination of Concussion: Medical and Cognitive Considerations"
Speaker: Kevin M Guskiewicz, PhD, ATC, Professor, Dept of Orthopedic Surgery, School of Medicine, University of North Carolina

Objectives: 1) Argue factors to be included in the diagnosis of concussion. 2) Highlight subjective reporting of symptoms versus clinical discovery. 3) Share treatment and management strategies.

Handouts: Handout PDF

April 13, 2012 - "Biomarkers in Neurologic Disease: Current & Future"
Speaker: Penelope Hogarth, MD, Associate Professor of Neurology and Medical & Molecular Genetics; Director of Clinical Research, Oregon Health & Science University

Objectives: 1) Define terminology of biomarkers. 2) Discuss the role of prognostic and predictive biomarkers in Parkinson's Disease. 3) Review the current regulatory landscape and the FDA's perspective on biomarkers and the future of personalized medicine.

Handouts: Handout PDF

March 16, 2012 - "Perinatal Mood and Anxiety Disorders: The role of the healthcare provider"
Speaker: Mary Ann Ahmed, MD, OB/Gyn, East Cascades Women's Group Wendy N. Davis, PhD, Executive Director, Postpartum Support International; Counseling and Consulting practice, Portland

Objectives: 1) Identify the challenges for medical providers faced when identifying and treating perinatal mood and anxiety disorders. 2) Describe the symptoms and discuss the differential diagnosis of the various perinatal mood disorders: depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar disorders and psychosis. 3) Indicate effects of untreated perinatal mood and anxiety disorders in pregnancy, birth, and postpartum. 4) Identify evidence-based prenatal and postpartum risk factors. 5) Describe co-existing childbearing complications affecting perinatal mental health. 6) Identify three reliable resources for medical providers to access information about medication during pregnancy and postpartum. 7) Identify reliable local resources and referral process for pregnant and postpartum women and families.

Handouts: Handout PDF: Perinatal Mood Disorders, Handout PDF: Myths and Facts About Perinatal Mood Disorders, Handout PDF: PMAD Fact Sheet, Handout PDF: Prenatal Info and Risk Factor Checklist for Moms, Flyer PDF: PSI Open Forum Session Flyer, Handout PDF: Types of Perinatal Mood Disorders, Handout PDF: UIC Perinatal Medchart

March 09, 2012 - "Critical Care Hematology: HIT, Massive Thrombosis, Transfusions (Yea or Nea)"
Speaker: Thomas DeLoughery, MD, Associate Professor, Division of Hematology & Medical Oncology, Oregon Health & Science University

Objectives: 1) Properly identify patients with HIT. 2) Understand the course for the development if HIT. 3) Describe the pathophysiology of clotting risks. 4) Differentiate from other benign hematologic conditions. 5) Understand treatment options.

Handouts: Handout PDF

March 02, 2012 - "Updates in the Management of Acute and Chronic Sinusitis"
Speaker: Ryan Gallivan, MD, Otolaryngology, Central Oregon ENT

Objectives: 1) Differentiate between acute and chronic sinusitis. 2) Identify key aspects of the history and physical exam and interpret diagnostic studies. 3) Discuss the indications for endoscopic sinus surgery. 4) Discuss outcomes and comparison of standard functional endoscopic sinus surgery vs. functional endoscopic dilatation of the sinuses. 5) Discuss management of post-operative care.

Handouts: Handout PDF

February 24, 2012 - "Health Literacy: Improving Quality through Patient-centered Communication"
Note: The lecture begins at 2:00. Please skip ahead to bypass chatter.

Speaker: Cliff Coleman, MD, MPH, Assistant Professor, Dept of Family Medicine, Oregon Health & Science University

Objectives: 1) Estimate the prevalence of low health literacy in the US and among patients in their local area. 2) Describe the rationale for using a "universal precautions" approach to health communication. 3) List at least five concrete steps practitioners can take to improve communication with their patients.

Handouts: Handout PDF, Flyer PDF

February 17, 2012 - "GERD: The Past and the Future"
Speaker: James Dolan, MD, FACS, Assistant Professor of Surgery, Dept of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University

Objectives: 1) Comprehend how the history of antireflux surgery influences the current therapies. 2) Discuss the elements of a surgical fundoplication. 3) Describe the long-term side effects of proton pump inhibitors. 4) Recognize that new therapies for GERD are evolving.

Handouts: Handout PDF

February 10, 2012 - "Guidelines for Diagnosis and Treatment of Food Allergies in the Primary Care Setting"
Speaker: Adam Williams, MD, Allergy Medicine, Bend Memorial Clinic

Objectives: 1) Discuss recently published NIH/NIAID guidelines for the diagnosis and management of food allergy. 2) Discuss appropriate food allergy tests for the primary care setting, and when to refer to an allergist. 3) Improve communication with and education of patients who request allergy tests of uncertain efficacy.

Handouts: Handout PDF, Flyer PDF

February 03, 2012 - "Claudication and Critical Limb Ischemia: Endovascular Treatment of Peripheral Arterial Disease"
Note: The lecture begins at 3:00. Please skip ahead to bypass chatter.

Speaker: Jason Wollmuth, MD, FACC, Heart Center Cardiology

Objectives: 1) Discuss the epidemiology of peripheral arterial disease. 2) Discuss the symptoms, differential diagnosis, and physical findings for PAD. 3) Compare and contrast medical, surgical and endovascular treatment options for PAD. 4) Using case studies, apply evidence-based guidelines for endovascular treatment of PAD.

Handouts: Handout PDF: Wollmuth Claudication and Critical Limb Ischemia, Flyer PDF

January 27, 2012 - "Perioperative Management of Anticoagulation and Antiplatelet Therapy"
Note: The attached "SCHS Anticoagulation Guidelines, Rev. B, 1/27/12" should replace the guidelines that were distributed at the 1/27/12 Grand Rounds. This contains an important correction related to the post-operative algorithm (pg 4). Attendees should disregard guidelines dated prior to Rev. B, 1/2712.

Speaker: Brooke Hall, MD; Steve Kornfeld, MD; Bruce McLellan, MD

Objectives: 1) Introduce new protocol for anticoagulation and antiplatelet therapy management. 2) Provide an overview of the challenges in managing perioperative anticoagulation. 3) Detail the thromboemoblic risk of the patient. 4) Explain the indications for bridging therapy. 5) Discuss the anticoagulants used for bridging. 6) Describe the postoperative anticoagulation algorithm. 7) Explain antiplatelet management for coronary artery and carotid stents.

Handouts: Handout PDF, Handout PDF: Anticoagulation Guidelines

January 13, 2012 - "Challenges and Advancements for Treating MRSA Infections in 2012"
Note: The lecture begins at 3:00. Please skip ahead to bypass chatter.

Speaker: Thomas Ward, MD, Asso. Professor, Division of Infectious Disease, Oregon Health & Science University, Jennifer Jordan, PharmD, BCPS, Assistant Professor, Pacific University, School of Pharmacy

Objectives: 1) Describe the role of MRSA as a community acquired and healthcare associated pathogen. 2) Discuss the relevance of IDSA guidelines for the treatment of MRSA infections. 3) Review antibiotics with activity against MRSA and describe their role in common infections. 4) Discuss methods to improve patient outcomes with MRSA infections, including diagnostic tests and pharmacokinetic/pharmacodynamic principles. 5) Describe the role of decolonization for patients.

Handouts: Handout PDF

January 06, 2012 - "Fetal Programming and the Role of Maternal Nutrition on the Risk of Childhood Disease"
Note: The lecture begins at 3:50. Please skip ahead to bypass chatter.

Speaker: Daniel L. Marks MD, PhD Asso. Professor, Pediatric Endocrinology; Director, Oregon Child Health Research Center, Oregon Health and Science University

Objectives: 1) Define the concept of fetal programming. 2) Explain the findings that support the idea that the placenta does not protect the developing fetus from a pro-inflammatory maternal lipid milieu. 3) Discuss the public health issue surrounding life threatening childhood obesity.

Handouts: Handout PDF