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2013 Grand Rounds Archive

Due to technical difficulties, select videos of the June 14 to current Grand Rounds are currently not available. A resolution is being implemented and videos will be posted as they become available. We apologize for the inconvenience.

December 27, 2013 - No Grand Rounds

December 20, 2013 - Disease Screening: Point-Counter Point
Speaker: Archie Bleyer, MD, Clinical Research Professor, Oregon Health & Science University, Fergus Coakley, MD, Diagnostic Radiology Chair, Oregon Health & Science University, Karen Oh, MD, Associate Professor, Diagnostic Radiology, Oregon Health and Science University

Objectives: This point-counter point panel discussion will address current controversies relative to cancer screening with an emphasis on mammography screening.

Handouts: Handout PDF 1, Handout PDF 2

December 13, 2013 - Annual Update in Outpatient Medicine
Speaker: Robert A Gluckman, MD, FACP, Internal Medicine Specialist; Chief Medical Officer, Providence Health Plans

Objectives: Using results from recent studies, discuss current evidence relevant to outpatient internal medicine. Topic areas will depend upon most recent publications.

Handouts: Handout PDF 1, Handout PDF 2

December 06, 2013 - "Parathyroids, Small but Mighty: Current Pathways to Early Diagnosis and Cure of Parathyroid Disease"
Speaker: Mira Milas, MD, FACS, Professor and Director of Endocrine Surgery, Dept of Surgery, OHSU

Objectives: 1) Using a diagnostic case review format, discuss parathyroid disease from the simple to the challenging. 2) Discuss indications for surgery when parathyroid tumors are present but calcium or PTH is normal. 3) Review imaging guidelines in parathyroid disease. 4) Discuss surgical options for primary hyperparathyroidism.

Handouts: Handout PDF

November 29, 2013 - No Grand Rounds


November 15, 2013 - "New Interventional Radiology Techniques in Bend: Minimally Invasive Cancer Therapy"
Objectives: 1) Discuss indications for minimally invasive catheter directed therapies for metastatic disease. 2) Discuss side effects, complications and post-procedure care, and expected outcomes.

Handouts: Handout PDF

November 08, 2013 - "Imaging for Trauma and the Acute Patient — What to Order When"
Objectives: 1) List considerations of radiation exposure unique to the pediatric patient. 2) Discuss CT as a diagnostic tool in the pediatric patient and the individual risk-benefit over MRI and Ultrasound. 3) Using case examples, discuss an appropriate imaging algorithm in the pediatric patient. 4) Understand appropriate indications for utilizing MRI in the emergency evaluation of patients with abdominal/pelvic pathology. 5) Discuss the limitations of MRI in the acutely ill patient and the uncooperative patient. 6) Discuss appropriate indications for brain and spine MRI in the acute setting, including utilization of contrast.

Handouts: Handout PDF

November 01, 2013 - "An Evidence Based Approach to Eating Disorders In Children"
Objectives: 1) Explain the different types of eating disorders. 2) Recognize the need to clinically evaluate patients for eating disorders. 3) Describe available treatment strategies for management of eating disorders.

Handouts: Handout PDF

October 25, 2013 - No Grand Rounds

October 18, 2013 - "Emerging Treatments for Parkinson's Disease"
Speaker: Donald C. DeLisi Jr., DMD, Bend Oral, Facial, & Implant Surgery

Objectives: 1) Discuss the clinical signs and implications of oral and maxillofacial trauma. 2) Review airway considerations in the facial trauma patient. 3) Review treatment modalities to surgically restore function to the facial trauma patient. 4) Discuss systematic best practices in the coordination of care from the ER to the floor.

Handouts: Handout PDF

October 11, 2013 - "Management of Oral and Maxillofacial Trauma"
Speaker: Donald C. DeLisi Jr., DMD, Bend Oral, Facial, & Implant Surgery

Objectives: 1) Discuss the clinical signs and implications of oral and maxillofacial trauma. 2) Review airway considerations in the facial trauma patient. 3) Review treatment modalities to surgically restore function to the facial trauma patient. 4) Discuss systematic best practices in the coordination of care from the ER to the floor.

Handouts: Handout PDF

October 04, 2013 - "New Trends in Endovascular Care"
Speaker: Wayne Nelson, MD, incoming medical director, Vascular Care, St. Charles; Vascular Surgery, Bend Memorial Clinic

Objectives: 1) Identify emerging trends, techniques and controversies in endovascular care. 2) Discuss indications for conservative versus interventional care.

Handouts: Handout PDF

September 27, 2013 - No Grand Rounds

September 20, 2013 - "Over-diagnosis, Over-treatment, Over-medicalization of Life"
Speaker: H. Gilbert Welch, MD, MPH, Professor, Dartmouth Institute for Health Policy and Clinical Practice & Geisel School of Medicine at Dartmouth

Objectives: 1) Assist primary and specialty care providers in understanding the relevance of overdiagnosis; 2) Review the requisites of successful cancer screening; 3) Illustrate with screening mammography the adverse impact of overdiagnosis; 4) Recognize the benefits of breast cancer screening and impact on mortality reduction.

September 13, 2013 - "Infectious Disease: Nothing to Smile About"
Speaker: Peter Milgrom, DDS, Professor of Dental Public Health Sciences and Pediatric Dentistry, University of Washington

Objectives: 1) Using evidenced-based research, describe the caries process as a communicable disease passed from primary caregiver to child. 2) Understand the need for initiating routine oral health care beginning at conception and the establishment of a dental home by age one. 3) Discuss the value of collaboration between medical and dental providers to promote optimal oral health throughout a patient’s lifetime. 4) Explain the medical management of caries in treating the dental infection instead of the restorative (i.e., drill and fill model). 5) Describe the role of the medical provider to increase preventive visits for pregnant women and children birth – 12 years, decrease emergency room visits for dental concern, and decrease unnecessary drug use.

Handouts: PDF Handout

September 06, 2013 - "Improving Outcomes in Pediatric Critical Care"
Speaker: Mark T. Buchholz, MD Pediatric Intensive Care Unit, Emanuel Children’s Hospital

Objectives: 1) Increase awareness of PICU outcomes and analyze the morbidity and/or mortality of cases presented. 2) Increase knowledge of treatment guidelines as appropriate to each case presented. 3) Identify conditions that may require remote pediatric critical care consultations. 4) Decrease the need for pediatric patients to be transferred.

Handouts: PDF Handout

July 19, 2013 - "Rheumatology Therapeutics: Perioperative DMARD Management, Infection and Malignancy Risks, Vaccination Considerations"
Speaker: Heather Hansen, MD, Deschutes Rheumatology

Objectives: 1) Know Broad Categories of Rheumatoid Arthritis Medications, 2) Know when to start and stop DMARDs in the Perioperative Period, 3) Recognize drugs that may increase risk for infection, 4) Understand malignancy risks associated with DMARD's, 5) Know vaccination recommendations forRheumatic Disease

Handouts: Handout PDF

June 28, 2013 - "Evidenced-based Care for Low Back Pain"
Speaker: Alison Little, MD, MPH, Director of Clinical Affairs at the Center for Evidence-based Policy at OHSU and Summer Boslaugh, MBA, MHA, Program Manager, Oregon Health Care Quality Corp

Objectives: Objectives:1) Understand and consistently apply the State of Oregon Evidence-based Clinical Guidelines Project Evaluation and Management of Low Back Pain Guidelines. 2) Understand current care. 3) Order imaging studies for back pain patients according to the Oregon Guidelines. 4) Be prepared to instruct and support patients in self-management of acute low back pain. 5) Make appropriate referrals for specialist consultation and/or percutaneous treatment of low back pain.

Handouts: Handout PDF, Baseline Utilization Report PDF, State Of Oregon Guideline Advanced Imaging For Low Back Pain PDF, State Of Oregon Guideline Evaluation Management Of Low Back Pain PDF, State Of Oregon Percutaneous Interventions PDF

June 21, 2013 - "Heroin Addiction in Central Oregon"
Speaker: Ronald Schwerzler, MD, Director of Medical Services, Serenity Lane, Eugene

Objectives: Objectives:1) Discuss the scope of heroin and other street drug use in the Pacific Northwest and Central Oregon regions. 2) Explain the biochemistry and actions of heroin. 3) Review the immediate (short-term) and long term effects of heroin use. 4) Discuss the medical complications of chronic heroin use. 5) Identify the signs and symptoms of heroin intoxication and withdrawal. 6) Discuss the legal requirements for prescribing medication for hospital patients who are in acute withdrawal, and issues around transfer of care. 7) Discuss treatment options for heroin addiction and list local resources for treatment.

Handouts: CME 06 21 13 Handout, CME 06 21 13 Handout 2

June 14, 2013 - "Management of Burns and Electrical Injuries"
Speaker: Joseph Pulito, MD, surgical burn specialist, Legacy Emanuel, Oregon Burn Center Curtis Ryun, RN, Burn Educator, Oregon Burn Center, Legacy Health

Objectives: 1) Identify the severity of a burn injury, with a focus electrical injuries. 2) State the ABCDEF’s of a burn injury during the first hour of care (airway damage, burns to chest wall for breathing problems, circulation management, disability status, exposure and cover, fluid resuscitation). 3) List the three do’s and three don’t of appropriate care of a burn injury. 4) State three criteria for transfer to a burn center and identify appropriate transfer protocols to the Oregon Burn Center.

Handouts: Handout PDF

June 07, 2013 - "Management of Drowning and Near Drowning"
Speaker: Janet Semple-Hess, MD, Attending Physician, Division of Emergency Medicine, Children's Hospital of Los Angeles, Associate Professor of Pediatrics, Keck USC School of Medicine

Objectives: 1) Review the epidemiology and pathophysiology of drowning. 2) Discuss the evidence behind management recommendations. 3) Review factors associated with prognosis (and their exceptions), and discuss preventative measures.

May 31, 2013 - "Coordinated Care Organizations: What it Means for Central Oregon Physicians"
Speaker: Mike Bonetto, PhD, MPH, MS, Health Policy Advisor to Governor Kitzhaber Dan Stevens, MBA, MPH, Sr Vice President, Government Programs, PacificSource Health Plans

Objectives: Using a didactic and Q&A format, this CME activity is designed to: 1) Provide an overview of current and future plans of local and state CCOs. 2) Provide an understanding of current initiatives in Central Oregon and new state incentive measures

Handouts: Handout PDF, Article PDF

May 17, 2013 - "Anticoagulant Management through the Trauma Experience"
Speaker: Thomas DeLoughery, MD, Associate Professor, Division of Hematology & Medical Oncology, Oregon Health & Science University

Objectives: 1) Recognize the indications for anticoagulation reversal in trauma patients. 2) Demonstrate the use of clotting factor replacement in anticoagulation reversal. 3) Explain the use of thrombelastography (TEG) and rapid TEG to guide therapy. 4) Discuss new agents and whether there is a role for platelet transfusion with antiplatelets in the trauma setting

Handouts: Handout PDF

May 10, 2013 - "Controversies in Prostate Cancer Screening"
Speaker: Eric Shreve, MD, Bend Urology Associates

Objectives: 1) Review recent randomized trials and assess the benefits of PSA screening for prostate cancer. 2) Discuss the advantages and disadvantages of PSA screening. 3) Review treatment guidelines for treatment of prostate cancer.

Handouts: Handout PDF

May 03, 2013 - "Update on Oral Antiplatelet Therapy in Coronary Artery Disease"
Speaker: Ty J. Gluckman, MD, FACC, Providence St. Vincent Heart and Vascular Institute, Portland, Oregon; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland

Objectives: 1) Review the benefits and risks of antiplatelet therapy in patients with coronary artery disease. 2) Discuss variability in response to antiplatelet therapy and the role of genotyping and platelet phenotyping. 3) Discuss the newer antiplatelet therapies and their role in the management of patients with an acute coronary syndrome.

Handouts: Handout PDF

April 26, 2013 - "Overcoming the Challenges of Teaching in Clinical Settings — What works?"
Speaker: George Mejicano, MD, MEd, Senior Associate Dean for Education, OHSU School of Medicine

Objectives: 1) Discuss converging challenges characterized as "The Four Horsemen" of the medical education apocalypse. 2) List possible solutions including the increasing role of technology in medical education and lifelong learning. 3) Describe the role of the community—based physician in medical education and how to overcome barriers to teaching.

Handouts: Handout PDF

April 19, 2013 - "Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT)"
Speaker: Jim Winkle, MPH, Project Director, Department of Family Medicine, Oregon Health & Science University

Objectives: 1) Discuss the research on SBIRT across settings. 2) Describe tools used for screening patients with alcohol and drug use. 3) Demonstrate a brief intervention and a referral to treatment while in a busy practice setting.

Handouts: Handout PDF

April 12, 2013 - "Surgical Advances in Treatment of Liver Cancer"
Speaker: Paul Hansen, MD, FACS; Program Director of Hepatobiliary and Pancreatic Surgery

Objectives: 1) Discuss research in the treatment of hepatocellular carcinoma, including new Hep C screening guidelines and management of new drugs. 2) Discuss indications for liver resection for primary and metastatic liver cancer. 3) Review indications, surgical techniques, and expected outcomes for laparoscopic liver resection.

Handouts: Handout PDF

April 05, 2013 - "Pediatric Diabetic Ketoacidosis (DKA) Management in the Emergency Room and Ensuring Stable Transition to ICU"
Speaker: Andrea Hoogerland, MD Pediatric Critical Care Medicine, Randall Children's Hospital — Legacy Emanuel

Objectives: 1) Discuss the signs and symptoms commonly associated with DKA in the pediatric patient. 2) Discuss bedside evaluation for DKA associated cerebral edema. 3) Discuss diagnostic studies and management of DKA in the ER. 4) Discuss guidelines for consultation and transfer to the ICU. 5) Discuss telehealth and indications for when it should be activated for pediatric patients in the ICU.

Handouts: Handout PDF

March 15, 2013 - "Best Practices for Reducing Surgical Site Infections"
Speaker: E. Patchen Dellinger, MD, Professor and Vice Chairman, Department of Surgery Chief, Division of General Surgery, University of Washington Medical Center, Seattle, WA

Objectives: 1) Describe ideal prophylactic antibiotic practice including which cases benefit from prophylaxis, which drugs to use, when to start, how much to give, and when to stop. 2) review the evidence supporting the use of oral antibiotics for patients having colorectal operations. 3) Outline the evidence supporting the maintenance of normothermia in the operating room. 4) Discuss the conflicting evidence regarding the provision of specific levels of FiO2 to surgical patients in the OR. 5) Discuss the influence of hyperglycemia on risk of developing a surgical site infection. 6) Review the data that hyperglycemia is also a risk for surgical patients who are not diabetic. 7) Discuss the evidence regarding reduction of surgical site infection risk from the use of surgical checklists and ensuring ideal teamwork and communication in the OR.

Handouts: Handout PDF

March 08, 2013 - "Robotic Urologic Surgery: A New Era in Patient Care"
Speaker: Matthew N. Simmons, MD, PhD, FACS, Urology Specialists of Oregon

Objectives: 1) Discuss the history of minimally invasive urologic surgery. 2) List the principles of robotic surgery.3) Discuss the principles and contemporary practice patterns for robotic prostatectomy and robotic partial nephrectomy, including outcomes. 3) Provide an overview of reconstructive urologic surgeries, and future directions in robotic urologic surgery.

Handouts: Handout PDF

March 01, 2013 - "Parent Training to Address Pediatric Functional Abdominal Pain: A Researcher's Perspective"
Speaker: Rona L. Levy, MSW, PhD, MPH, Professor and Director, Behavioral Medicine Research Group, Adjunct Professor of Medicine, Division of Gastroenterology, Department of Medicine; Professor, School of Social Work, University of Washington, Seattle, WA

Objectives: This education activity will provide an historical perspective of research in pediatric recurrent abdominal pain and the role of cognitive social learning theory in patient health outcomes, including evidence that parental change is a key element in reducing children's symptoms.

Handouts: Handout PDF

February 22, 2013 - "Current Concepts in Transfusion: Morbidity and Mortality"
Speaker: Mark Popovsky, MD, Chief Medical Officer, Haemonetics Corporation, Laurel Yocom, MD, Chief of Pathology Division, St. Charles Medical Center-Bend

Objectives: 1) Review the epidemiology of transfusion-associated circulatory overload (TACO), transfusion-related acute lung injury (TRALI) and other common transfusion reactions. 2) Recognize the clinical significance of common transfusion reactions, and identify mitigation strategies. 3) Identify which transfusion reactions are reportable and which are not. 4) Review evidence-based clinical practice guidelines for usage of blood products. 5) Using local data, discuss efforts to improve use of autologous RBCs in orthopedic elective cases (hip and knee replacement surgery).

Handouts: Handout PDF: Current Concept in Transfusion, Handout PDF: Yocom, Handout PDF: Yocom Additional

February 15, 2013 - "Medication Nonadherence in Cardiovascular Medicine: Patients, Pills and Population Health"
Speaker: Gregory Roth MD, MPH, Division of Cardiology — Medicine; Institute for Health Metrics and Evaluation, University of Washington

Objectives: 1) Discuss the problem of medication non-adherence at both the patient and population level. 2) Describe existing methods for measuring and tracking medication adherence for cardiovascular pharmacotherapy. 3) Assess interventions that improve medication adherence.

Handouts: Handout PDF

February 08, 2013 - "Addressing the Physical Health Needs of People with Severe and Persistent Mental Illness in Rural Settings"
Speaker: Lori E. Raney, MD, Chair, American Psychiatric Association's Workgroup on Integrated Care and Medical Director, Axis Health System, Durango, CO.

Objectives: 1) Describe the co-morbid physical illnesses in patients with severe and persistent mental illness (SPMI). 2) Discuss common mistakes physicians and providers make when working with SPMI populations in primary care, specialty care, emergency or inpatient settings. 3) Describe different options for providing primary health care to patients with SPMI. 4) Describe rationale for providing primary care services in a mental health setting. 5) List models of care used to provide primary care services in mental health settings.

Handouts: Editorial PDF, Handout PDF

February 01, 2013 - "Best Practices for Managing Patients with Advanced Heart Failure"
Speaker: James Mudd, MD, Assistant Professor of Cardiology; Director, Heart Failure and Heart Transplantation, Cardiovascular Medicine, Oregon Health & Science University

Objectives: 1) Discuss key questions in the epidemiology, pathophysiology and treatment of patients with advanced heart failure. 2) Identify appropriate patients for transfer of care to heart failure facility.

Handouts: Handout PDF

January 25, 2013 - "Cultural Competency: Critical to Safe, Patient- and Family-centered Care"
Note: The presentation and slides begin at 4:57. Please skip ahead to bypass chatter.

Speaker: Sunita Mutha, MD, FACP, Professor of Medicine, Division of General Internal Medicine, University of California, San Francisco

Objectives: 1) Provide an overview of cultural competency from both an organizational and clinician viewpoint. 2) Discuss the relevance of cultural competency in national quality improvement initiatives and its impact on providers/clinics, healthcare organizations, payors and health plans. 3) Using case examples, discuss the limitations and potential patient safety issues when using interpreters who are not trained medical interpreters. 4) List interpreter and education resources available to providers.

Handouts: Handout PDF

January 18, 2013 - "Evidence-based Clinical Guidelines for Managing Hypothyroidism in Ambulatory Adults"
Speaker: Peter A. Singer, MD, Professor of Clinical Medicine; Director, Thyroid Diagnostic Center, Keck School of Medicine of the University of Southern California

Objectives: 1) Discuss the clinical presentation of hypothyroidism. 2) Review evidence-based clinical guidelines for managing hypothyroidism in ambulatory adults. 3) Discuss management of patients who are using natural therapeutics for hypothyroidism.

Handouts: Handout PDF

January 11, 2013 - "How a Greek Grandmother Would Solve the Health Care Crisis: Which Diet and Lifestyle Choices Really Matter?"
Speaker: Miles Hassell MD, Medical Director, Department of Integrative Medicine, Providence Cancer Center

Objectives: 1) Review the data supporting particular lifestyle choices that impact specific components of risk, such as heart disease, diabetes, cancer and stroke. 2) Discuss micronutrient deficiencies that occur in patients on low-fat vegan diets, and the risks associated with becoming too zealous. 3) Discuss patient education tools and referral sources to promote self-management.

Handouts: Handout PDF