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Due to technical difficulties, select videos of the 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 26, 2014 - No Grand Rounds Due to Christmas Holiday Weekend

December 19, 2014 - “Differential Diagnosis and Treatment of EoE”
Speaker: Rabindra Watson, MD, Clinical Instructor of Medicine Interventional Endoscopy Services Division of Digestive Diseases David Geffen School of Medicine at UCLA

Objectives: Objectives: 1) Discuss the rising prevalence of eosinophilic esophagitis (EoE). 2) Discuss the differences between EoE from gastroesophageal reflux disease. 3) Discuss best treatment approaches for EoE.

Handouts: CME_121914_Watson, CME_121914_Watson_HOs

December 12, 2014 - “Recognition of Adrenal Insufficiency: A Silent but Deadly Problem”
Speaker: Mark Goodarzi, MD, PhD, Director, Division of Endocrinology, Diabetes & Metabolism; Cedars-Sinai Medical Center; Associate Professor of Medicine, David Geffen School of Medicine at UCLA

Objectives: Objectives: 1) Using case examples, establish a diagnosis of adrenal insufficiency, and differentiate between primary and secondary adrenal insufficiencies. 2) Discuss immediate treatment for adrenal insufficiency in both the outpatient and acute care setting. 3) Discuss new sepsis guidelines and the role of hydrocortisone in treating adrenal insufficiency.

Handouts: CME_121214_Goodarzi, CME_121214_Goodarzi_HOscolor

December 05, 2014 - “Crisis Care: Responding Effectively in a Public Health Emergency”
Speaker: Richard Leman, MD, Medical Epidemiologist and Chief Medical Officer Health Security, Preparedness and Response Program Oregon Health Authority, Oregon State Public Health Division with Nathan Boddie, MD, St. Charles Hospital Medicine, Oregon Crisis Care Guidance Workgroup member

Objectives: Objectives: 1) Identify examples of two types of public health crisis: one in which physical infrastructure would be intact, one in which it would be severely disrupted. 2) List three categories of strategies that promote effective healthcare response in a public health crisis. 3) Describe at least one mechanism through which the Oregon Crisis Care Guidance could be used to improve readiness for crisis care response within the St. Charles Health System service area.

Handouts: CME_120514_Leman_Boddie, CME_120514_Leman_Boddie_HO

November 28, 2014 - No Grand Rounds

November 21, 2014 - "Conflict: Talking So People Will Listen and Listening So People Will Talk"
Speaker: Daniel O’Connell, PhD Clinical Psychologist, University of Washington; Consultant to the Institute for Healthcare Communication; Faculty, Foundation for Medical Excellence

Objectives: Objectives: 1) Increase understanding of how and why disagreements occur. 2 Describe the attitudes and techniques for increasing safety in risky conversations. 3) Demonstrate the difference between "Pushing" and "Pulling" in conversation about disagreement. 4) Internalize the mantra "Never furious, always curious" as an aid to managing one's own emotions when negotiating disagreement.

Handouts: CME_112114_OConnell_HOs

November 14, 2014 - No Grand Rounds

November 07, 2014 - "Early Discussion and Resolution of Adverse Healthcare Incidents”
Speaker: Gwen Dayton, Oregon Medical Association General Counsel and Vice President, Health Policy; Gary Bruce, VP/General Counsel SCHS

Objectives: Objectives: Using a case based scenario and Q&A format, physicians and all health care professionals will gain an understanding of Oregon’s Early Discussion and Resolution process, and how it will be interpreted by malpractice carriers and facilities.

Handouts: CME_110714_combined_HOs

October 31, 2014 - “2014 Update in Perioperative Management of Anticoagulation and Antiplatelet Therapy"
Speaker: Brooke Hall, MD; Steve Kornfeld, MD; Bruce McLellan, MD

Objectives: Objectives: 1) Discuss current perioperative anticoagulation guideline. 2) Describe novel anticoagulants and their reversal. 3) Explain antiplatelet management for coronary artery and carotid stents.

Handouts: CME_103114_Hall_Kornfeld_McLellan

October 17, 2014 - “Effective Pharmacological Management of Chronic Pain”
Speaker: Gregory L. Holmquist, Pharm.D., BCOP

Objectives: Objectives: 1) Examine effective strategies for titrating opiate medications, based on patient need and evidence-based best practices. 2) Identify which patients may benefit from reducing opiate medications, increasing opiate medications, or switching to alternative pain management techniques/medications 3) Improve confidence in prescribing opioid medications and management of chronic pain patients.

Handouts: CME_Oct17_Holmquist

October 10, 2014 - "2014 Update on Deep Vein Thrombosis/Pulmonary Embolism”
Speaker: Thomas DeLoughery, MD, FACP, Prof. of Medicine, Pathology, and Pediatrics, Divisions of Hematology/Medical Oncology and Laboratory Medicine, OHSU

Objectives: Objectives: 1) Apply evidence-based guidelines and quality measures for VTE risk stratification in the acute-care setting. 2) Promote adherence to evidence-based VTE prophylaxis to ensure continuity of care post-discharge.

Handouts: CME_Oct10_DeLoughery

October 03, 2014 - "The Importance of Evidence Based Practice: Using it to Support Your Patient Care Decisions"
Speaker: Roger Chou, MD, FACP, Prof. of Medicine & Medical Informatics & Clinical Epidemiology, OHSU / Director Pacific Northwest Evidence-based Practice Center; PANEL: Karoline Almanzar, MLIS Assoc. Director of Access & Delivery Western Univ. of Health Sciences/COMP-NW COMP and Stephanie Kerns, MLS, Assoc. University Librarian for Information & Research Services, OHSU

Objectives: Objectives: 1) Discuss the importance of using evidence-based practice in patient care decision making. 2) Discuss evidenced-based methodology used in reliable resources. 3) Discuss use of on-line evidence-based literature at point of care for timely and informed medical decision making.

Handouts: CME_103_Chou_panel

September 26, 2014 - TRAUMA CME “Evaluation and Management of Sport-Related Concussion in Youth: Clinical, Research & Public Health Strategies”
Speaker: Gerard A. Gioia, PhD, Chief, Division of Pediatric Neuropsychology; Director, Safe Concussion Outcome, Recovery & Education (SCORE) Program, Children's National Health System; Professor, Depts. of Pediatrics and Psychiatry George Washington University School of Medicine

Objectives: Objectives: 1) Describe history and evolving state of mild TBI/concussion as related to sports 2) Describe clinical and public health methods for evaluation of sport-related concussion 3) Discuss traditional and newer models of concussion/ mild TBI management 4) Identify key areas of research need in pediatric mild TBI.

Handouts: 926_GioiaGuskiewicz

September 19, 2014 - “Evolution of the Bedside Exam”
Speaker: Brion Benninger, MD, MSc, Professor, Executive Director, Medical Anatomy Center, Dept of Medical Anatomical Sciences, Dept of Neuromuscular Medicine, Western University of Health Sciences, COMP-NW

Objectives: Objectives: 1) Understand how Ultrasound is currently being taught to medical students as an extension of the physical exam 2) An overview of the use of Ultrasound for thoracic procedures – controversial anatomy with novel fast exam using ultrasound. 3) An overview of the use of Ultrasound for abdomen – controversial anatomy and fast exam using Ultrasound.

Handouts: 919_Benninger

September 12, 2014 - “Learning Together to Practice Together”
Speaker: Jann Balmer RN, Ph.D. Director, The School of Medicine, Office of CME University, Virginia Health System

Objectives: Objectives: 1) Describe the urgency and changing landscape for healthcare practice. 2) Define what interprofessional learning is and what it is not. 3) Provide examples of interprofessional education and team-based learning. 3) Provide a forum to discuss differing perspectives on the impact of interprofessional education in medical education and in practice.

Handouts: 912_Balmer_ HOs

September 05, 2014 - “My Brain Has A Hole in It: A Patient's Perspective”
Speaker: Gordon and Jill Viggiano, public speakers, My Brain, LLC; Michel Boileau, MD, Chief Clinical Officer, St. Charles Health System

Objectives: Objectives: 1) Provide an overview of the “patient engagement” framework and how it can be applied in the inpatient and outpatient setting. 2) Using personal narrative and imagery, explain what a stroke patient is feeling even though the patient cannot verbalize it. 3) Understand what is important from the beginning of a patient’s stay. 4) Apply new concepts when treating patients by seeing them and their issues in a different light.

July 30, 2014 - No Grand Rounds until September 2014

July 18, 2014 - “Surveillance and Treatment of Zoonotic Diseases”
Speaker: Emilio DeBess, DVM, MPVM, Public Health Veterinarian for the State of Oregon

Objectives: Objectives: 1) Discuss the surveillance and treatment of zoonotic diseases, including Lyme disease, West Nile virus and avian influenza. 2) Discuss patient education points in preventing exposure to zoonoses.

Handouts: CME_071814_DeBess_Handout

June 27, 2014 - “Polypharmacy and Patient Safety: Addressing a National Issue”
Speaker: Kristy Butler, PharmD, BCPS, BCACP, FASHP, Manager, Clinical Pharmacists, Clinical Pharmacy Department Providence Medical Group

Objectives: 1) Discuss the concept of polypharmacy and potential drug-drug interactions, particularly in high risk, high cost, complex patients. 2) List prescribing practices that help reduce the risk of an adverse drug event in older adults. 3) Discuss the concept of integrating clinical pharmacy services into the care and management of high risk, high-cost, complex patients

Handouts: CME_062714_ButlerK_Handout

June 20, 2014 - “An Integrative Approach to Pain Management"
Speaker: Mary Ann Iyer, MD, MA, Internist, author, former medical director for the Division of Integrative Medicine for Samaritan Health Services, Corvallis, and Scott Safford, PhD, Licensed Psychologist, Behavioral Health Consultant, St. Charles Family Care

Objectives: 1) Review the elements of the pain syndrome, to include the impact of psychological components on physiology. 2) Have at hand a ready method to evaluate ameliorating or exacerbating elements of the pain picture in her/his patient. 3) Learn basic mindfulness techniques that make the life, work and role of the clinician easier and more focused

Handouts: CME_06202014_PainHandoutQuestionnaire, CME_06202014_PainTalk_Handout, CME_06202014_PPT

June 13, 2014 - “Management of Thyroid Nodules and Thyroid Cancer”
Speaker: Mira Milas, MD, FACS, Professor and Director of Endocrine Surgery, Dept of Surgery, OHSU

Objectives: 1) Discuss new guidelines about best options for thyroid imaging and indications for thyroid ultrasound and FNA. 2) Discuss innovations for the indeterminate thyroid biopsy and how molecular markers are changing patient care. 3) Discuss screening for Cowden’s and other hereditary thyroid cancer syndromes in every day practice. 4) Discuss outcomes for robotic thyroid surgery. 5) Discuss the prevalence, significance, diagnosis and management of thyroid incidentaloma.

Handouts: CME_06132014_Milas_Handouts

June 06, 2014 - “Management of Pediatric Respiratory Emergencies”
Speaker: James Andrus, MD, Pediatric Critical Care, St. Rose Dominican Hospitals - Rose de Lima Campus, Henderson, NV

Objectives: 1) Identify etiologies associated with airway distress with an emphasis on asthmatic emergencies. 2) Appropriately assess the pediatric patient experiencing an asthmatic emergency. 3) Discuss guidelines for consultation, and transfer to the ICU. 4) Discuss telehealth resources and when it should be activated. 5) List preventative strategies or pediatric asthma that will reduce preventable admissions.

Handouts: CME_06062014_JAndrus_Handout

May 30, 2014 - Trauma CME “Management of Traumatic Brain Injury: coordinating care across all specialties”
Speaker: Viviane Ugalde, MD, Chief of Rehabilitation & Physical Medicine Division; Megan Gleason, Physical Therapist, Inpatient Rehab; Emily Lapore, Speech Language Pathologist, Inpatient Rehab; Matthew Witts, Occupational Therapist, Acute Rehab

Objectives: 1) Discuss best practices for managing the traumatic brain injury (TBI) patient through the continuum of care (from the ICU, acute care, and inpatient rehabilitation). 2) Utilize different means of bridging communication gaps to improve the care of the TBI patient. 3) Based on cognitive scales, discuss proper ways for the medical team to communicate and interact with the TBI patient and their family in the acute inpatient rehab setting. 4) Discuss prevention strategies and list local resources.

Handouts: CME_053014_Ugalde_panel_Handout

May 16, 2014 - "Updates in the Initial Treatment of Traumatic Brain Injury"
Speaker: Kent Yundt, MD, Neurosurgery, NW Brain and Spine

Objectives: 1) Discuss the cerebral physiology and pathophysiology (the brain’s response to traumatic injury). 2) Present a literature review of current guidelines for the treatment of traumatic brain injury, including an algorithmic approach for initial management of traumatic brain injury.

Handouts: Handout PDF

May 09, 2014 - "Navigating Difficult Conversations with Patients and Families"
Speaker: Daniel O’Connell, PhD Clinical Psychologist, University of Washington; Consultant to the Institute for Healthcare Communication; Faculty, Foundation for Medical Excellence

Objectives: 1) Describe the attitudes and demeanors of clinicians who manage difficult conversations well. 2 Understand and diagnose how different pictures of what is possible through treatment (success), specific unrecognized expectations for diagnostic and treatment options and insufficient flexibility on the part of the clinician can all trigger and exacerbate conflict with patient and family. 3) Describe and demonstrate the ADOBE Model for turning around difficult interactions with patients and families.

Handouts: Handout PDF

May 02, 2014 - "Common Herbal Medical Pitfalls"
Speaker: Cyrus Rangan, MD FAAP, Assistant Medical Director, California Poison Control System, Los Angeles; Director, Los Angeles Medical Toxicology Education Program; Peds Hospitalist, Valley Presbyterian Hospital, Van Nuys, CA

Objectives: 1) Classify common herbal medications. 2) Recite the physician’s role in the federal laws that monitor adverse events to OTC drugs and herbal supplements. 3) Assess the use and misuse of common herbal medications outlining the various side effects and/or drug efficacy. 4) Compare the different cultures’ unique levels of acceptance of herbal treatment.

Handouts: Handout PDF

April 25, 2014 - "Headaches: Novel Approaches to Diagnosis and Treatment"
Speaker: Stephen Ireland, MD, Neurology of Bend

Objectives: Recognize the spectrum of benign recurring headaches and apply various approaches to treatment.

Handouts: Handout PDF

April 18, 2014 - "The Neuroscience of Integrative Body-Mind Training"
Speaker: Michael Posner, PhD Professor Emeritus, Department of Psychology, University of Oregon; Adjunct Professor, Weill Medical College in New York (Sackler Institute)

Objectives: Using recent research data, explore the link between integrative body-mind training and neural mechanisms for conscious control of behavior (e.g., smoking cessation).

Handouts: Handout PDF, Brief meditation training induces smoking reduction

April 11, 2014 - "A Clinician's Guide to Parkinson's"
Speaker: John Nutt, MD, Depts of Neurology and Physiology & Pharmacology, Oregon Health & Science University

Objectives: 1) Understand how to diagnose Parkinson's disease and differentiate it from some other common disorders. 2) Recognize the many non-motor symptoms of Parkinson's disease. 3) Know the basics of management every physician, not just the neurologist, should be familiar with. 3) List local resources for patient education and advocacy.

Handouts: Handout PDF

April 04, 2014 - "Caring for the Medical Patient with Acute Opiate Withdrawal"
Speaker: Richard Ries, MD, Professor of Psychiatry; Director, Division of Addictions University of Washington and Harborview Medical Center

Objectives: 1) Review the US national epidemic of opioid prescription medication use, dependence and accidental overdose deaths. 2) Review methods of opioid withdrawal in hospitalized patients. 3) Review and understand medications helpful for treatment of opioid dependency as outpatients.

Handouts: Handout PDF

March 28, 2014 - No Grand Rounds

March 21, 2014 - "Transfer of Patients with Type 2 Diabetes to Insulin"
Speaker: Eden Miller, DO, Family Medicine, High Lakes Health Care, Sisters

Objectives: Discuss the importance of reducing barriers to self-management both within and outside of the clinic setting by addressing the nature and the skills needed to identify and resolve barriers to adherence. Highlights from the 2013 Advanced Insulin Management meeting will be presented.

Handouts: Handout PDF

March 14, 2014 - "Update on HIV Drug Therapy: A Case‐based Discussion"
Speaker: Philip Grant, Assistant Professor, Division of Infectious Diseases at Stanford University

Objectives: Review the optimal choices of antiretroviral medications in antiretroviral-naïve HIV-infected individuals with challenges to treatment success. Examine the limitations and advantages of newly approved and soon-to-be approved antiretroviral medications.

Handouts: Handout PDF

March 07, 2014 - "Compassion Fatigue: Theory, Neuroscience, and Practical Protective Factors"
Speaker: Christopher Wilson, Psy D Psychologist, Portland, OR

Objectives: Understand the neuroscience behind the theory that suggests compassion fatigue and empathy have a counterintuitive relationship. 2) Understand the risk factors for compassion fatigue. 3) Understand three protective factors for coping with situations that may lead to compassion fatigue.

February 28, 2014 - "Updates in Hospital Medicine"
Speaker: Michelle Mourad, MD, Assistant Professor, Division of Hospital Medicine University of California San Francisco

Objectives: 1) Review 10 articles that will change or confirm current hospital medicine practices. 2) Describe possible changes in the use of risk stratification & diagnostic tests for hospitalized medical patients.

Handouts: Handout PDF

February 21, 2014 - "ICD-10: Are You Ready?"
Speaker: Timothy Schulte, MD, DCBA, Inc., Atlanta, Georgia

Objectives: 1) Understand the future of the practice of medicine in the value-based era. 2) Demonstrate knowledge of ICD-10 requirements and its effect on physician billing. 3) Demonstrate how physicians and hospitals can work together to improve a physician’s profile and benefit their patients.

Handouts: Handout PDF

February 14, 2014 - "Recognizing Cyclic Vomiting Syndrome in the Emergency Department and Beyond"
Speaker: Thangam Venkatesan MD, Associate Professor of Medicine, Fellowship Director, Division of Gastroenterology and Hepatology, Department of Internal Medicine Medical College of Wisconsin and Maren Nelson, RN, FNP/DNP-S, University of Portland

Objectives: 1) Discuss the historical perspective and epidemiology of CVS. 2) List the diagnostic criteria and clinical presentation for CVS. 3) Discuss the clinical profile of CVS including common co-existing conditions in adults. 5) Discuss current theories of pathogenesis. 6) Discuss diagnostic test and differential diagnosis and current treatment guidelines. 7) Discuss how an individualized care plan for CVS diagnosed patients will improve patient outcomes and decrease visits to the ED.

Handouts: Handout PDF

February 07, 2014 - "Management of Non-muscle Invasive and Invasive Bladder Cancer"
Speaker: Brian T. O'Hollaren, MD, Bend Urology Associates

Objectives: 1) Describe the signs and symptoms, diagnostic tests and staging of bladder cancer. 2) Identify treatment strategies for non-muscle invasive and muscle invasive bladder cancer. 3) Address nonsurgical options currently employed (x-ray therapy, chemotherapy), and strategies when surgical options fail.

Handouts: Handout PDF

January 31, 2014 - "The Quality, Safety, and Value Movements: Why Transforming the Delivery of Healthcare is No Longer Elective"
Speaker: Robert M. Wachter, MD, Prof. and Associate Chair of the Department of Medicine at the University of California, San Francisco

Objectives: In this talk, Dr. Wachter will review the brief history of the quality and safety movements, the new push for "value" (quality + safety + patient satisfaction divided by cost), and how all of these levers (accreditation, regulation, transparency, payment changes) are combining to create unprecedented pressure on caregivers and delivery organizations to change their ways of doing business. Rather than being depressed, participants will leave with a deep understanding of healthcare's new landscape, and a roadmap (and some optimism) for success in this new world.

Handouts: Handout PDF

January 24, 2014 - "Resuscitation 2014"
Speaker: Martin Schreiber, MD, Chief, Division of Trauma, Critical Care and Acute Care, OHSU

Objectives: 1) To discuss the significance of hemorrhage as a source of death after trauma. 2) To define the etiology of coagulopathy after trauma. 3) To discuss the goals of resuscitation after trauma. 4)To discuss current and novel strategies for the resuscitation of trauma patients. 5) To discuss adverse events associated with blood transfusions.

Handouts: Handout PDF

January 17, 2014 - “Understanding and Implementing the New Definition of Malnutrition”
Speaker: Terese Scollard, MBA, RD, LD, Regional Clinical Nutrition Manager, Providence Nutrition Services

Objectives: 1) Examine updates on the relationship of inflammation, serum albumin and relationship to adult disease-related malnutrition. 2) Increase understanding to apply the (2012) international consensus characteristics for adult disease-related malnutrition and their application in patient care. 3) Demonstrate how consistent documentation enables clinicians to better establish prevalence of malnutrition and in turn target cost effective interventions. 3) Examine in-office and hospital tools to reduce incidence and identify patients at risk for adult disease-related malnutrition. 4) Discuss future care models to prevent the negative economic impact of adult disease-related malnutrition.

Handouts: Handout PDF - Malnutrition, Handout PDF - Adult Malnutrition Criteria, Handout PDF - Consensus Statement, Handout PDF - Malnutrition Recognition, Data Collection and Reporting, Handout PDF - Paragon Wound Dietician Documentation, Handout PDF - Physician Exam

January 10, 2014 - "The Role of Nutrition in Cancer Prevention"
Speaker: John A. Tayek, MD, Director of Community Health Plan, Harbor UCLA Medical Center

Objectives: 1) Describe how a low fat diet may reduce the incidence of ovarian cancer. 2) Review evidence that low vitamin D levels are associated with a 2 to 3 fold increased risk for lung cancer in non-smokers. 3) Review data that a diet high in Omega 3 (fish oil) may reduce one's risk for breast cancer.

Handouts: Handout PDF

January 03, 2014 - No Grand Rounds