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Grand Rounds - November 10, 2023  
"UTI, Recurrent UTI, and Imitators"

Speaker: Christopher J. Graber, MD, MPH. Associate Clinical Professor of Medicine, David Geffen School of Medicine at UCLA; Staff Physician, Infectious Diseases Section VA, Greater Los Angeles Healthcare System.

 

 

Objectives

  1. Describe the evaluation and treatment of women with UTI.
  2. Identify recurrent UTI and alternative diagnoses such as interstitial cystitis and asymptomatic bacteriuria.
  3. Explain new theories about the microbiome of the bladder and how it impacts UTI and recurrent UTIs.
  4. Describe the proper usage of antibiotics in treating patients with these conditions.

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 cme@stcharleshealthcare.org.

Oher CME or Clerkship questions: also contact Continuing Medical Education at cme@stcharleshealthcare.org.

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UPDATE: Tickets have been sold out!

Tickets are available now for the 32nd annual Prineville Hospice Auction at the Crook County Fairgrounds indoor arena in Prineville on Dec. 2. The auction raises funds to support St. Charles’ hospice programs. The popular event includes a live auction of elaborately decorated Christmas trees and handmade quilts, as well as a buffet dinner, raffle and silent auction.  

“This is a wonderful tradition that builds community and celebrates the holiday season, all while raising money for a worthwhile cause,” said Jenny O’Bryan, executive director for the St. Charles Foundation. “Tickets are selling out quickly, so we encourage anyone interested in getting one while they still last.”

Starting this year, individuals can now purchase tickets online at hospiceauction.org. Advanced tickets are required.

Doors for the event open at 4:30 p.m., dinner begins at 6 and the auction begins at 7 p.m. A preview of the trees and quilts will take place Saturday from noon to 1 p.m.

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Last week, St. Charles Madras hosted a team of medical executives from the Japan Association for Development of Community Medicine (JADECOM), who were visiting the area as part of an effort to learn more about rural family medicine in the US. The collaborative visit included seven executives from Japan as well as representatives from OHSU Department of Family Medicine, which has a longstanding exchange program for medical residents, students, and physicians from Japan (learn more about the program). For years, the OHSU exchange program brought physicians to other rural areas in Oregon, but beginning this year, St. Charles Madras will host a portion of the exchange program. This is one of the many benefits of new Three Sisters Rural Track residency program, which will welcome its first class of residents in 2024.

This October, the team from Japan visited the OHSU campus and then came to Madras, so the executives could learn more about how rural family medicine is handled here and see where residents pursuing rural family medicine would train during their visits.

Dr. Daisuke Yamashita, associate professor of family medicine with OHSU, said the visit was successful and the team enjoyed seeing the health campus in Madras, which connects public health, Mosaic Community Medical (the federally qualified health center) and the hospital.

“This is an opportunity to reflect on and recognize the common threads that are universal in our health care systems, despite the differences in circumstances and cultures. This provides an opportunity to recognize strengths and areas of improvement,” Yamashita said.

Dr. Jinnell Lewis, director of the Three Sisters Rural Track Program, said in addition to providing a chance to collaborate and learn, this exchange is also special for the Madras community in particular. For many years Madras has had a sister city in Japan, Tomi City, and students have an exchange program between the two towns.

“This deepening of our connection with Japan and its medical community is one of the many benefits of the partnership we have with OHSU through the Three Sisters Rural Track residency program,” Lewis said.

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Grand Rounds - November 3, 2023  
"Wound Assessment and Management"

Speaker: Andrew Vardanian, MD. Assistant Clinical Professor, Division of Plastic Surgery, UCLA Department of Surgery.

 

 

Objectives

  1. Cite the physiology of wound healing and identify factors that may impair healing.
  2. Identify patients at risk for developing pressure ulcers.
  3. Compare and select diagnostic tests related to wound classification and assessment.
  4. Compare and select modalities used for acute and chronic wound management, including topical therapies, surgical revascularization, and debridement.
  5. Select strategies for enhancing wound healing and prevention by identifying and treating pressure ulcers, wound complications, and infections timely.
  6. Provide wound care instructions to patients at discharge.
  7. Recognize patients at greater risk for wound complications and impaired wound healing, taking into consideration the patient’s age, ethnicity, socioeconomics, etc.

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 cme@stcharleshealthcare.org.

Oher CME or Clerkship questions: also contact Continuing Medical Education at cme@stcharleshealthcare.org.

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St. Charles Urology specializes in medical diseases of the urinary-tract system and the reproductive organs. We provide comprehensive diagnosis and treatment or surgical options to best fit your needs.

St. Charles Urology’s highly skilled and experienced team is committed to providing you with exceptional care, because your urological health is important to us. We will partner with your referring primary provider to determine the appropriate course of treatment and ensure the best possible outcome for you.

We offer evaluation and treatment of:

  • Urinary tract disorders, including infections

  • Kidney stones and kidney disease

  • Incontinence and overactive bladder

  • Male sexual health

  • Prostate health

  • Urological cancers

Our specialized services include:

  • Urodynamics

  • Bladder instillation: BCG, Botox

  • PTNS

  • Voiding trials

  • Catheterization

  • Vasectomy

Because urological conditions can cause embarrassment or discomfort, we emphasize sensitivity and discretion when dealing with all issues and concerns.

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I read a story today that warmed my heart.

It was about a St. Charles caregiver named Desiree, who works in our Prineville Family Care clinic, and her 12-year-old daughter Zoe, who was born with an aortic valve that didn’t quite work right.

Desiree always knew Zoe would need heart surgery someday, but a growth spurt accelerated that need to this past summer. The family learned in June that Zoe would need the procedure, and within days it was scheduled for mid-July.

That’s great from a care perspective. But for Desiree, it came with added stress: Not anticipating the surgery, she had used her available time off, and her situation didn’t qualify for family medical leave or short-term disability.

Suddenly, she found herself facing the prospect of a two-week stay with Zoe in Portland, and no paycheck to help cover the bills. For a moment, she thought she might have to choose between accompanying Zoe and paying her rent.

That’s where St. Charles Cares comes into the picture. A fund of the St. Charles Foundation, the Cares fund supports our caregivers who experience economic hardship and are unable to afford housing, utilities or other basic living needs because of circumstances beyond their control.

A colleague encouraged Desiree to apply for Cares funding, and she was awarded $1,500 to help cover her rent, reducing her bills and allowing her to take off work and be with her daughter in Portland, where she could focus on helping Zoe recover. (I’m happy to report that Zoe is doing great, by the way.)

St. Charles Cares distributes about $17,000 annually and is funded by donations from the community as well as our own caregivers, who give generously because they know their money will go to help one of their own when they need it most.

In fact, our annual internal fundraising campaign – Giving Together: One St. Charles – is underway as we speak. If you’d like to support our caregivers and their support of each other, you can do so on the Foundation’s website by using the drop-down menu to designate your donation for “Caregiver Support.”

It is this spirit – caring for each other as we care for the communities we serve – that makes St. Charles a special place. I’m incredibly proud to be a part of it.

Sincerely,
Steve

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After Charlie Hoffmeister had her first baby at age 28, her body changed. She started struggling with her pelvic floor — the muscles spanning between the tail and pubic bones, which cradles the organs above it.

Pelvic floor dysfunction after childbirth is a widespread ailment. In fact, one in three women will be affected by a pelvic floor issue at some point in their life. Symptoms can include loss of bladder or bowel control and pain during intercourse, as well as low back or hip pain. And these frustrating symptoms aren’t just limited to people who have recently given birth: Men and women, young and old, can experience pelvic floor dysfunction, with severity ranging from inconvenient to life-altering.

In Hoffmeister’s case, the time she spent recreating outside dwindled, and she wasn’t as able to join her child in play.

“I was annoyed,” she said. “I felt like it really limited my ability to be the adventurous, rock climbing, running person that I had been.”

Although awareness about pelvic floor dysfunction is becoming more common, it’s still a relatively hushed topic. In part, that’s because it centers around a private area of the body, said Brooke Collins, a pelvic floor and physical therapist who started St. Charles’ pelvic floor therapy program more than a decade ago.

Pelvic floor therapy sessions begin with a thorough consultation, including a physical exam, and then center on the unique needs of a patient’s pelvic floor muscles, which either need to be strengthened or relaxed — or sometimes both. The ultimate goal? For the patient to regain control of their body. Pelvic floor therapy helps 97% of patients with stress urinary incontinence, for example, and cures it for 73% of patients.

“When there's dysfunction there, it can affect every aspect of your life,” Collins said. “We're helping people get control back so that their body is functioning the way they want.”

For patients whose muscles are weakened, a program plan will typically include exercises, not just for the pelvic floor muscles but also for the surrounding hip and core muscles. Patients with overly tight pelvic floor muscles will learn relaxation techniques. In both scenarios, practitioners employ biosensors that reflect muscle activity in real-time on a screen, allowing patients to understand better what is happening in their bodies.

Hoffmeister says she felt more confident after just the first session. After returning for another eight-week round of pelvic floor therapy following the birth of her twins, she could lace up her sneakers and get back into running after only six months postpartum. Now, at 33, she has no remaining symptoms, and she encourages anyone struggling with pelvic floor dysfunction to at least have a consultation, even if they ultimately decide against therapy, because it is empowering to learn about how the body works and what is considered normal, she said.

“You’re not alone; it’s very common,” Collins said. “Don’t put up with it, and don’t give the companies that make pads any more money.”

Learn more about the pelvic floor therapy services, which are offered at St. Charles' clinics in Madras, Prineville and Redmond.

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Pictured above are Melissa Chalker, Anthony Mattioda and Dominic Mattioda sitting on Guy's bench. Pictured below are Anthony and Dominic, plus Guy's sister Gina and his parents, Faye and Jerry.

When Melissa Chalker graduated from college and started working at St. Charles Bend 32 years ago, one of her jobs was to deliver paper patient charts from the medical records department to the Emergency Room.

“I would do that 10 or 12, maybe 15 times each day,” she said. “And when I did that, I had to pass the satellite phlebotomy station in the main hallway twice, once on the way and once on the way back.”

One day, she spotted someone new at the station: Guy Mattioda, a phlebotomist who had recently moved from night shift to days. Mattioda was friendly and had a great sense of humor. It wasn’t long before they started dating and were married in 1993.

“If it wasn’t for that job change, I’m not sure we would’ve found each other,” Chalker said.

Eventually, Chalker moved into utilization management and Mattioda became a Registered Nurse, where he earned the nickname “Father Guy” because of his ability to put patients and families at ease. They both got to know many St. Charles caregivers. The couple’s sons, Anthony and Dominic, were both born in the Bend hospital, as well.

“St. Charles has been an important part of our life,” Chalker said.

Life changed, however, in February of 2003, when Mattioda passed away. His funeral was held at the Catholic church in downtown Bend, and it overflowed with people mourning his loss.

“I have always felt like that was a great testament to him. There were tons of people from the hospital: Doctors, nurses, people he knew, people I knew,” Chalker said. “It was really, really heartwarming.”

After the funeral, St. Charles nurses supported the family by delivering food and collecting money to install a memorial bench in Mattioda’s honor. The bench is located just outside the hospital’s main entrance.

“They asked me what the plaque should say, and I thought, ‘What touches people the most?’” Chalker said. “I think it was his smile, because he was always smiling. That’s why we put, ‘Forever smiling, Forever in our hearts.’”

For the past 20 years, Jerry and Faye Mattioda have visited the bench outside St. Charles as a way to remember and honor their son, who grew up in the family’s home just down the road from the Bend hospital. Guy also took religious classes in Sister Catherine’s home when he was a child.

“It was very touching when they placed the bench after he died, and it’s very touching now,” Jerry Mattioda said. “Time goes by, but the memory is always there.”

Over the years, the family had worked with St. Charles’ Facilities crew on upkeep of the bench, but in recent years, Mattioda noticed that it was really starting to show its age. He and Chalker discussed another round of “loving care,” Mattioda said, but word of their concerns got to Derek Miller, director of Facilities for the health system, who had a different idea: To replace the original bench, which was nearing its end of life, and install the new one in the same location.

“I can’t thank Derek enough for how quickly and graciously he responded to our request. I could stand here all day thanking him and his team, because this just means that much to our lives,” Jerry Mattioda said. “St. Charles was a very special place to Guy. He loved his job and he loved what he did here.”

On a sunny Friday afternoon in late September, the family gathered under the trees outside the Bend hospital for a short, simple ceremony, where Jerry said a few words about Guy, then Anthony and Dominic removed the original bench and put the new one in place. There were stories told and photos taken, soft chuckles and tears on cheeks. And now there is a nice, clean, new place for patients, visitors and caregivers at St. Charles Bend to sit and reflect, whether or not they remember the person behind the name on the plaque.

“The real story is kindness: The kindness of Guy and the kindness of our coworkers,” Chalker said, “and the fact that his legacy lives on.”

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Grand Rounds - October 20, 2023  
"Idiopathic Pulmonary Fibrosis: Diagnosis and Management"

Speaker: Olanrewaju Esan, MD, MBA, FACP, FCCP, FAASM. Medical Director, West Hempstead Sleep Disorders Center.

 

 

Objectives

  1. Differentiate idiopathic pulmonary fibrosis (IPF) from other common ILDs.
  2. Apply evidence informing the use of antifibrotic therapy, nonpharmacologic strategies, and management of risk factors and comorbidities in patients with IPF.
  3. Individualize treatment of IPF.

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 cme@stcharleshealthcare.org.

Oher CME or Clerkship questions: also contact Continuing Medical Education at cme@stcharleshealthcare.org.

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Enduring Materials - Oct 20, 2023      
"Delirium or Dementia? Practical Guide to Differentiation and Management"

Speaker: Maureen Nash, MD FAPA ACP DFAAGP. Medical Director, Providence ElderPlace PACE Oregon.

 

Objectives

  1. Learners will be able to define delirium and dementia.
  2. Attendees will understand and be able to list 2 screening tools for delirium.
  3. Attendees will understand and be able to list 2 screening tools for dementia.

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of St. Charles Health System and the Older Adult Behavioral Health Initiative. St. Charles Health System is accredited by the ACCME to provide continuing medical education for physicians. St. Charles Health System designates this live virtual activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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 cme@stcharleshealthcare.org

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