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2011 Grand Rounds Archive

December 30, 2011 - No Grand Rounds (New Years Holiday)
Objectives:  

December 23, 2011 - No Grand Rounds (Christmas Holiday)
Objectives:  

December 16, 2011 - "Palliative Care 101 (Part 2)"
Speaker: Lisa Lewis, MD, Medical Director, Partners in Care/Hospice House; with panel moderated by Laura Mavity, MD, Medical Director, Advanced Illness Management and Home Health Programs

Moderator: Dr. David Tretheway, Medical Director Hospice of Redmond/Sisters Dr. Sonia Thakur, Medical Director of Mountain View Hospice and Newberry Hospice Dr. Michael Knower, Medical Director of Pioneer Memorial Hospice

Objectives: Using a case presentation and moderated panel format, participants will have a better understanding about Medicare hospice benefit, eligibility, and local resources.

Handouts: Handout PDF, Handout PDF

December 09, 2011 - "Palliative Care 101 (Part 1)"
Note: The video recording starts at page 5 of the handout.

Speaker: Laura Mavity, MD, Medical Director, Palliative Care, St. Charles Health System

Objectives: Discuss the requirements for POLST completion and POLST registry requirements. 2) Review hospice services and eligibility requirements. 3) Demonstrate skills for care goal discussions.

Handouts: Handout PDF

December 02, 2011 - "Incorporating Lifestyle Medicine into Practice"
Speaker: Anne Nedrow, MD, MBA, Associate Professor, Department of Medicine; Medical Director, Women's Primary Care and Integrative Medicine, Center for Women's Health, Oregon Health & Science University

Objectives: 1) Describe the essential elements of lifestyle medicine (including exercise, nutrition, weight management, smoking cessation, and stress management). 2) Introduce practical tools to enable physicians to incorporate lifestyle medicine strategies into their practice.

Handouts: Handout PDF

November 18, 2011 - "The Changing Shape of Bariatric Surgery"
Speaker: D. Scott Diamond, MD, General Surgery, Advanced Specialty Care

Objectives: 1) Identify co-morbidities related to morbid obesity and how bariatric surgery affects them. 2) Identify metabolic effects of bariatric surgery. 3) Understand the rationale for bariatric surgery as preventive medicine.

Handouts: Handout PDF

November 11, 2011 - "Never-28 Events"
Speaker: Gregg A. Bendrick, MD, MPH, Chief Medical Officer, NASA Dryden Flight Research Center, Edwards Air Force Base, California

Objectives: 1) List the "Never-28" events of healthcare. 2) Recognize the role of physicians and hospitals in reporting the "Never-28" events. 3) Discuss roles of leadership in establishing effective patient safety management systems. 4) Discuss elements of a culture that is both safe and just, holding people accountable for their actions when appropriate.

Handouts: Handout PDF

November 04, 2011 - "What is a Professional? Redefining our identity in the healthcare world" Note: Queue up video at 6 min. 12 seconds
Note: Queue up video at 6:12.

Speaker: Barry Egener, MD, Medical Director, The Foundation for Medical Excellence

Objectives: 1) Demonstrate how the concept and manifestations of "professionalism" are dependent on the systems in which they are viewed. 2) Advance a series of "professionalism competencies" for health care organizations. 3) Consider the evolving issues in central Oregon in light of these two concepts.

Handouts: Handout 1 PDF, Handout 2 PDF, Handout 3 PDF

October 21, 2011 - "The Future of CME and Why it is Important for US Healthcare"
Speaker: George C. Mejicano, MD, MS, Associate Dean for Continuing Professional Development School of Medicine and Public Health

Objectives: 1) Compare and contrast the terms "continuing medical education (CME)" and "continuous professional development (CPD)." 2) Determine how CPD can help clinicians improve the quality of care delivered to their patients. 3) Understand what is meant by both Maintenance of Certification and Maintenance of Licensure and how they will affect physicians over the next 5—10 years. 4) Understand what licensing authorities and certifying boards currently require for CPD and soon will require in the next 5 -10 years.

Handouts: Handout PDF

October 14, 2011 - "Diastolic Heart Failure: Diagnosis and Treatment"
Speaker: William Grossman, MD, Professor, Department of Medicine, Division of Cardiology, UCSF School of Medicine

Objectives: 1) Demonstrate an understanding of the principles of therapy for acute and chronic systolic and diastolic dysfunction and prescribe appropriate, evidence-based treatments, based on ACC/AMA guidelines. 2) Cite therapy for subgroups; gender, race. 3) Discuss drugs contraindicated in CHF. 4) Demonstrate an awareness of management of refractory CHF. 5) Integrate concepts of self-management in their practice. 6) Assess prognosis and outcomes with optimal therapeutic measurements.

Handouts: Handout PDF

October 07, 2011 - "Motivational Interviewing: Improving Patient Outcomes Through Improving Communication"
Speaker: Kim Swanson, PhD, Behavioral Health Consultant, St. Charles Family Care — Redmond Ryan Dix, PsyD, Behavioral Health Consultant, MMORE Clinic — Prineville

Objectives: 1) Discuss the basic principles of motivational interviewing (MI). 2) Identify stages of change in the context of assessing opportunities for interventions to promote behavior change. 3) Review strategies for enhancing patients' motivation to change. 4) Apply and integrate MI communication techniques into clinical encounters with patients.

Handouts: Handout PDF

September 30, 2011 - "Hantavirus Pulmonary Syndrome"
Speaker: Brian Hjelle, MD, Professor of Pathology; Adjunct Professor of Molecular Genetics and Microbiology; Adjunct Professor of Biology; Instructor, MPH Program; University of New Mexico School of Medicine

Objectives: 1) Using a case presentation format, address the differential for hantavirus cardiopulmonary syndrome (HCPS). 2) Discuss the history and pathophysiology of HCPS. 2) Identify treatment options for HCPS.

Handouts: Handout PDF

September 23, 2011 - "Optimal lifestyle choices for reversing Insulin Resistance, the Metabolic Syndrome, and Type 2 Diabetes: What really works?"
Speaker: Miles Hassell, MD, Medical Director, Integrative Medicine Program, Providence Cancer Center

Objectives: 1) Discuss the role of insulin resistance in disease, including diabetes, stroke, heart disease, and cancer. 2) Review the lifestyle choices available for preventing and reversing insulin resistance. 3) Identify particular lifestyle choices that impact specific components of risk, such as central obesity, high triglycerides, low HDL, and hypertension.

Handouts: Handout PDF

September 16, 2011 - "Practical Aspects of the Oral New Anticoagulants"
Speaker: Thomas G. DeLoughery, MD, FACP, Professor of Medicine, Pathology, and Pediatrics, Division of Hematology/Medical Oncology, Dept of Medicine; Division of Laboratory Medicine, Dept of Pathology, OHSU

Objectives: 1) Review the properties of the new anticoagulants in development. 2) Review the results of clinical trials involving novel anticoagulants, including: prevention of thrombosis in total knee arthroplasty, prevention of thrombosis in total hip arthroplasty, therapy of acute thrombosis, and prevention of stroke in atrial fibrillation. 3) Discuss practical issues associated with the advent of new antithrombotic drugs, including who should be changed over, "off-label" use, use in cancer patients, mechanical heart valve patients, pregnancy, monitoring, and reversal.

Handouts: Handout 1 PDF, Handout 2 PDF

July 22, 2011 - "Falls Prevention from the Ground Up"
Speaker: Diana Koin, MD, Associate Clinical Professor of Medicine, University of California, San Francisco; Elder and Dependent Adult Abuse Expert

Objectives: Objectives: 1) Using national and local data, identify and assess patients at risk for falls. 2) Prevent outpatient, hospital and nursing home falls. 3) Prevent complications of falls (including anticoagulation therapy in patients at risk for falls). 4) Discuss cultural and socioeconomic factors associated with falls.

Handouts: Handout PDF

July 15, 2011 - "Empowering Physicians and Improving Patient Outcomes through Awareness Practices"
Speaker: Elisha Goldstein, PhD, Private Practice in West Los Angeles; co-author of A Mindfulness-Based Stress Reduction Workbook

Objectives: 1) List four major mindfulness-based interventions in the field of health and medicine today. 2) Describe three formal mindfulness practices to enhance awareness, cultivate self care and self-compassion within the workplace and at home. 3) Describe attention management practices to be more effective in focusing on patient-centered care. 4) Understand, describe and practice specific exercises to cultivate greater empathy and awareness around psychosocial factors leading to patient illness. 5) Name three ways to work with the great unnamed epidemic, lack of self-compassion.

Handouts: Handout PDF

July 08, 2011 - "Straight Poop on C.diff"
Speaker: Jon Lutz, MD, Infectious Disease, Bend Memorial Clinic

Objectives: 1) Recognize recurrent C.difficile infection. 2) Discuss treatment of recurrent C. difficile infection and methods of prevention.

Handouts: Handout 1 PDF, Handout 2 PDF

July 01, 2011 - No Grand Rounds
Objectives:  

June 24, 2011 - "Prevention and Management of Hospital-Acquired Pressure Ulcers"
Speaker: Ian Gordon, MD, PhD, Director, University of California Medical Center Wound Clinic; Clinical Professor, Chief Vascular Surgery, VA Medical Center Long Beach

Objectives: 1) Identify patients at risk for acquiring pressure ulcers. 2) Describe clinical symptoms according to their different stages. 3) Describe preventive measures. 4) Understand how hospital acquired pressure ulcers adversely affect patient care outcomes. 5) Apply evidence-based guidelines.

Handouts: Handout PDF

June 17, 2011 - "Transition Planning for Youth with Developmental Disabilities"
Speaker: Randall Phelps, MD, PhD, Assistant Professor of Pediatrics, Developmental and Behavioral Pediatrician, Child Development and Rehabilitation Center, Oregon Health and Science University

Objectives: Through case-based discussion, participants will 1) Illuminate commonly encountered barriers to successful transition for youths with special healthcare needs. 2) Explore services and supports available in the community to assist families in overcoming these barriers. 3) Become familiar with the ICF (International Classification of Functioning), a function-based framework developed by the WHO, which can be used to facilitate transition planning.

Handouts: Handout PDF

June 10, 2011 - "A Rapid Evaluation TIA Clinic: How it is done"
Note: Grand Rounds in the Center for Health & Learning at St. Charles Medical Center — Bend, Conference Rooms C & D, and broadcast live to Blue Mountain Hospital, Lake District Hospital, Harney District Hospital, Mt. View Hospital District, Pioneer Memorial Hospital and St. Charles - Redmond

Speaker: Raymond N. Englander, MD, FAAN, FAHA, Medical Director, Stroke Center at Sacred Heart Medical Center

Objectives: 1) To become familiar with worldwide literature supporting the safety, efficacy, and cost savings of outpatient TIA assessment. 2) To understand validated grading scales for identifying a TIA vs mimics, and scales for assessing the short term risk of a stroke following a first TIA. 3) To review the successes and challenges in setting up and running a TIA clinic.

Handouts: Handout PDF

May 20, 2011 - "Non-Blood Medical and Surgical Management"
Note: Lynn Boshkov, MD, Associate Director of Transfusion Medicine, Head, Hemostasis and Thrombosis at OHSU.

Speaker: Raymond N. Englander, MD, FAAN, FAHA, Medical Director, Stroke Center at Sacred Heart Medical Center

Objectives: 1) Using a case presentation format, describe the medical and cultural issues in treating patients who refuse blood products. 2) Review the impact of new technologies in bloodless
Assessed Need: The Hospital Liaison Committee for Jehovah's Witnesses requests that education be provided to hospitals that will assist medical professionals when treating Jehovah's Witnesses and others who may request non-blood medical management. Links to ACGME/ABMS competencies, "Medical knowledge" about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social behavioral) sciences and the application of this knowledge to patient care.

Handouts: Handout PDF

May 13, 2011 - "Managing Melanoma (Part 2): A panel discussion"
Speaker: Andrew Jones, MD, General Surgery, Inovia

Moderator: Mark Hall, MD, Central Oregon Dermatology; Gerry Peters, MD, Bend Memorial Clinic; Cora Calomeni, MD, St. Charles Cancer Center; Bill Martin, MD, St. Charles Cancer Center

Objectives: Improve patient outcomes by educating practitioners in early recognition and excision of primary lesions, and ensure that high-risk patients have appropriate dermatologic screenings and treatment. Areas of focus will include: 1) Distinguishing pigmented lesions (continued); 2) The importance of patient education; 3) When genetic testing is needed; 4) Adjuvant therapy and emerging treatments for metastatic disease.

Handouts: Handout PDF, Dr. Hall Handout PDF, Dr. Martin Handout PDF, Dr. Peters Handout PDF, Dr. Peters Brochure Handout PDF

May 06, 2011 - "Managing Melanoma (Part 1): A panel discussion"
Speaker: Facilitated by Andrew Jones, MD, General Surgery, Inovia

Moderator: Leslie Carter, MD, Deschutes Dermatology Center; Stephanie Trautman, MD, Bend Dermatology; Will Delgado, MD, Bend Dermatology; Stephen Pool, MD, Cascadia Histopathology

Objectives: Improve patient outcomes by educating practitioners in early recognition and excision of primary lesions, and ensure that high-risk patients have appropriate dermatologic screenings. Areas of focus will include: 1) Distinguishing pigmented lesions (part 1); 2) Melanoma in unusual locations; 3) Biopsy of the pigmented lesion (what not to do); 4) Microstaging and key pathologic features.

Handouts: Dr. Carter Handout PDF, Dr. Delgado Handout PDF, Dr. Pool Handout PDF, Dr. Trautman Handout PDF

April 29, 2011 - "Osteoarthritis Update - What Can We Do?"
Speaker: Michael L. Caravelli, MD, Orthopedic Surgeon, The Center: Orthopedic & Neurosurgical Care & Research

Objectives: 1) Discuss the causes of degenerative arthritis, and the impact of new techniques and technologies.

Handouts: Handout PDF

April 22, 2011 - "Case Studies in Domestic Violence: Developing a deeper understanding of the role of the physician"
Speaker: Christopher F. Wilson, Psy.D, Psychologist in Private Practice, Portland

Objectives: Using a case study format, participants will be able to: 1) Differentiate between domestic violence and common couple violence or, as stated in the literature, "intimate terrorism" and "high conflict couples." 2) Identify at least three signs of potential domestic violence/intimate terrorism. 3) Develop a deeper understanding of the professional and personal role a physician can play in helping to end domestic violence.

Handouts: Handout PDF

April 15, 2011 - "Update in Outpatient Internal Medicine"
Speaker: Robert A Gluckman, MD, FACP, Chief Medical Officer-Teaching Clinics, Providence Medical Group

Objectives: 1) Using results from recent studies, discuss current evidence relevant to outpatient internal medicine. Topic areas include: ASA in PAD; BP and lipids in DM; ICD and CRT in CHF; Aldosterone antagonists in CHF; Dabigatran; PSA screening; prostate cancer treatment in low risk disease; and polypharmacy in the elderly.

Handouts: Handout PDF

April 08, 2011 - "Clinical Practice with Abused Women: Strategies and Realities"
Speaker: Jacquelyn C. Campbell, PhD, RN, FAAN, Anna D. Wolf Chair and a Professor in the Johns Hopkins University School of Nursing, with joint appointment in the Bloomberg School of Public Health, and National Program Director of the Robert wood Johnson Foundation Nurse Faculty Scholars Program.

Objectives: Following this Q & A format, practitioners will gain tools that will enable them to address the following scenarios: 1) What do you do when a patient is accompanied to the exam room with their abuser? 2) What do you do once you have made an evaluation and you have a strong suspicion? 3) What are your legal and ethical obligations? 4) Who is really an effective contact for intervention? 5) What are practical strategies physicians can employ in a busy clinic setting?

Handouts: Handout 1 PDF, Handout 2 PDF, Handout 3 PDF

April 01, 2011 - "Physician-patient Communication as a Tool that Can Change Adherence"
Speaker: Bruce G. Bender, PhD, Professor, Department of Pediatrics; Head, Division of Pediatric Behavioral Health, National Jewish Health; Denver, Colorado

Objectives: Review the barriers to patient adherence, particularly with pharmacological therapy. 2) Employ effective communication tools to improve adherence, and tailor this to fit a patient's individual needs.

Handouts: Handout PDF

March 25, 2011 - No Grand Rounds (SPRING BREAK)
Objectives:  

March 18, 2011 - No Grand Rounds (SPRING BREAK)
Objectives:  

March 11, 2011 - "Risk of Toxoplasmosis Infection in the United States"
Speaker: Jose Montoya, MD, Associate Professor, Medicine, Infectious Diseases, Stanford School of Medicine.

Objectives: Using a case presentation format of local cases of toxoplasmosis or where toxoplasmosis was in the differential, identify the ways in which humans can acquire Toxoplasmosis infection. 2) Develop a treatment plan for toxoplasmosis infection.

Handouts: Handout PDF

March 04, 2011 - "Osteoporosis Update: How are we doing with fracture intervention?"
Speaker: Molly Omizo, MD, Internal Medicine, Deschutes Osteoporosis Center

Objectives: 1) Describe current therapies for the treatment of osteoporosis. 2) Describe screening methods and national recommendations for dexascans. 3) Review published fracture intervention programs.

February 25, 2011 - "Violence and Aggression in Youth"
Speaker: Sheryl A. Ryan, MD, Associate Professor of Pediatrics; Chief, Section of Adolescent Medicine, Yale University School of Medicine

Objectives: 1) Define bullying and differentiate between bullying and other acts of aggression and violence. 2) Describe key research findings about bullying and apply them to clinical work in prevention and intervention. 3) Discuss myths about violence and violent youth. 4) Identify best practices in prevention and intervention in bullying.

February 18, 2011 - "Advances in the Management of Atrial Fibrillation: A Focus on Optimizing Cardiovascular Outcomes"
Speaker: Peter James Kudenchuk, MD, Professor of Medicine, Division of Cardiology, University of Washington School of Medicine

Objectives: 1) Discuss the natural clinical progression of AF and review current guidelines for the management of AF. 2) Describe the impact of co morbid conditions on the management of AF, particularly CHF. 3) Implement pharmacologic and ablative strategies for optimizing cardiovascular outcomes in patients with AF. NOTE: This CME has been offered to us by Horizon CME through a joint sponsorship with University of Cincinnati. CME credit is provided by University of Cincinnati.

February 11, 2011 - "A Look at Transitions in Medical Education"
Speaker: Scott Fields, MD, Vice Chair of the Department of Family Medicine, OHSU

Objectives: 1) Describe how medical education is transitioning to prepare medical students for the health systems in which they will work. 2) Discuss the characteristics of medical student applicant pools, and the motivations of rural versus urban applicants. 3) Discuss ways to incorporate ACGME core competencies into daily interactions when teaching medical students.

February 04, 2011 - "Stereotactic Radiation Therapy with 5 Treatments or Less?"
Speaker: Russ Omizo, MD, Radiation Oncology, St. Charles Cancer Center

Objectives: 1) Identify how new technologies have impacted our standard delivery of treatment for early stage lung cancer. 2) Discuss the benefits, risks and outcomes of using stereotactic body radiation therapy in selected patients.

Handouts: Handout PDF, Handout PDF

January 28, 2011 - "How Surgeons Can Lead the Delivery of Safe and High Quality Care: The Checklist and Beyond"
Speaker: Brett Sheppard, MD, Professor of General Surgery, OHSU; Board member, Oregon Patient Safety Commission

Objectives: 1) The rationale for using a safe surgery checklist. 2) Discuss the characteristics of a safe surgery checklist, and the barriers for implementing a checklist. 3) Identify activities in the OR that meet and do not meet the intent of the checklist

Handouts: Handout PDF

January 21, 2011 - "Clinical Research in Central Oregon: What's Available to You, Our Community, and Why"
Speaker: Archie Bleyer, MD, Medical Director of Clinical Research, Cancer Care, St. Charles Health System Timothy Beard, MD, Medical Director, Research Department, Bend Memorial Clinic

Objectives: 1) Understand why clinical research is crucial to Central Oregon. 2) Realize the breadth of clinical trials open to entry at our healthcare facilities. 3) Discover what the IRB is and how it helps assure that our clinical trials are optimal. 4) Appreciate future plans for our clinical trials infrastructure

Handouts: Handout PDF

January 14, 2011 - "Addiction to Food and Obesity: Reality and Recovery"
Speaker: Stephen Archer, MD, Advanced Specialty Care; Chair, Bariatrics Committee, St. Charles Bend

Objectives: 1) Provide evidence of addiction to food as a causative issue with some obese patients. 2) Discuss the role of addiction treatment in treating obesity, including the role of surgery as an intervention in the addiction process, and the role of support groups/therapy. 3) Discuss the issue of prior recovery efforts for other addictions and its role on success with obesity treatment. 4) Introduce the audience to patients who identify themselves as food addicts and are willing to give their personal experience and answer questions.

Handouts: Handout PDF

January 07, 2011 - "Resuscitating Hope for the Failing Heart of Healthcare"
Speaker: Valerie Ulstad, MD, MPA, MPH, FACC, Cardiologist. Independent Consulting Practice, Bloomington, Minnesota. Director, Archibald Bush Leadership Fellowship Leadership Development Program and the Courage to Imagine Professional Renewal Retreat Series for Bush Medical Fellows for the Bush Foundation.

Objectives: 1) Recognize the cycle triggered by the reflex response change. 2) Understand that the quality of our relationships with colleagues, staff and patients is the heart of healthcare. 3) Recognize the symptoms of distress and burnout in self and others. 4) Understand the concept of paradox and choosing a constructive point of tension between two things that are true and yet competing. 5) Develop a more conscious relationship with time and use of time as a representation of priorities. 6) Name three next steps you can take to promote work-life balance for yourself.

Handouts: Handout 1 PDF, Handout 2 PDF