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December 07, 2018 - "Adverse Reactions to Food Additives"
Speaker: Ronald A. Simon, M.D. Head, Allergy, Asthma and Immunology Adjunct Member, Department of Molecular and Experimental Medicine The Scripps Research Institute, San Diego, CA, Assistant Clinical Professor of Medicine and Pediatrics

Objectives: 1) Identify the additives most commonly associated with reactions 2) Describe the relationship between food additive sensitivity and conditions like CIU, asthma and hyperactivity/attention deficit disorder 3) Evaluate patients who have a history of reactions to food and drug additives.

Handouts: CME_120718_Simon

November 30, 2018 - "A Primary Care Approach to Diagnosing and Treating Infertility"
Speaker: Shahin Ghadir, M.D., F.A.C.O.G. Reproductive Endocrinologist Southern California Reproductive Center, Assistant Clinical Professor David Geffen School of Medicine at UCLA, Keck School of Medicine of USC

Objectives: 1) Identify the social determinants of fertility and infertility 2) Discuss the socio-economic demographics of reproductive-age couples in Central Oregon, and their unique characteristics 3) Describe the step-wise method for treating infertility, starting with an initial work-up, evaluation and counseling 4.) Review the most common causes of infertility and identify the current recommended courses of action for treatment 5) Inform about resources available in the community, region and state for treating infertility 6) Compare effectiveness of common infertility treatments and describe new, novel treatments available.

Handouts: CME_113018_Ghadir

November 23, 2018 - No Grand Rounds - Thanksgiving
Objectives: No Grand Rounds due to Thanksgiving holiday.

November 16, 2018 - TRAUMA CME “Top 10 Papers in Acute Care Surgery”
Speaker: Martin Schreiber, MD, Division Chief for Trauma, Critical Care and Acute Care Surgery, OHSU

Objectives: 1) Discuss management of patients with complex trauma and emergency general surgery diseases 2) Review critical new ideas in acute care surgery.

Handouts: CME_111618_Schreiber

November 09, 2018 - "Cardiac Testing: Meaningful Patient Care in the Age of Guideline and Appropriate Use Criteria Overload"
Speaker: Gary Foster, MD, St. Charles Cardiology

Objectives: 1) Discuss agendas driving Guidelines and Appropriate Use Criteria 2) Review ideal agendas for good patient care 3) Explain the strengths and shortcomings of major cardiac testing modalities.

Handouts: CME_110918_Foster

November 02, 2018 - "How to Help Colleagues with Addiction - New Options" Reliant Behavioral Health - Health Professionals' Services Program
Speaker: Christopher Hamilton, PhD, RBH’s Monitoring Programs Director; Robbie Bahl, MD, private practice in Portland OR

Objectives: 1) Describe the background and current components of Oregon’s physician health program the Health Professionals’ Services Program. 2) Discuss the statutory purpose of Oregon’s health professional regulatory boards. 3) Recognize signs of addition. 4) Refer health professionals portraying behavioral health needs to the Health Professionals’ Services Program.

Handouts: CME_110218_BahlHamilton

October 19, 2018 - “Tick-Borne Diseases of North America”
Speaker: Johan Bakken MD, PhD, FACP, FIDSA Infectious Diseases Consultant, St. Luke’s Medical Center, Duluth, Minnesota

Objectives: 1) Teach the epidemiology of tick borne diseases in USA 2) Review proper evidence based laboratory testing 3) Educate about proper anti-infective drugs for common tick borne illnesses.

Handouts: CME_101918TickborneInfectionsNorthAmericaHOs

October 12, 2018 - “Updates in Psoriasis”
Speaker: Teri Greiling MD, PhD, Assistant Professor in the Department of Dermatology – School of Medicine at OHSU

Objectives: 1) Discuss the efficacy and safety of newly approved therapies for psoriasis 2) Discuss the efficacy and safety of promising therapies in the pipeline for psoriasis 3) Review updates in the comorbidities of psoriasis. Please note: The video has a delay in the beginning. The lecture begins at 15:36.

Handouts: CME_101218GRUpdatesinPsoriasis_Greiling

October 05, 2018 - “An Update on Medical Use of Cannabis (with a focus on new study results)”
Speaker: Jacci Bainbridge, Pharm.D., University of Colorado Denver, Skaggs School of Pharmacy and Pharmaceutical Sciences

Objectives: 1) Review the pharmacology of cannabis (including drug-drug interactions including salves and oils). 2) Identify the disease states which may be treated with cannabis. 3) Review current medical literature and studies on the medicinal efficacy of marijuana (evidence for and against effectiveness). 4) Describe communication strategies for prospective patients considering or using cannabis treatment. 5) Discuss a case study and patient experience with diagnosis, treatment and management.

Handouts: CME_100518_Bainbridge_HOsAnUpdateMedicalUseCannabisNewStudyResultsNeurology

September 28, 2018 - “Acupuncture: An Alternative to Opioid for Pain Relief”
Speaker: Tanuja Goulet, Doctor of Acupuncture and Oriental Medicine, Licensed Acupuncturist Bend, OR

Objectives: 1) Interpret studies of acupuncture research in terms of efficacy and effectiveness for pain in short-term and long-term outcomes 2) Interpret studies of acupuncture research in terms of quality of life outcomes in short-term and long-term follow-up 3) Apply acupuncture research concepts to assist in recommending non-drug treatment for complex patients with chronic pain 4) Use presentation concepts to counsel patients on choices in their care 5) Review pain conditions that do not respond to acupuncture

Handouts: CME_092818_Goulet_Acupuncture

September 21, 2018 - "Update in Outpatient Medicine"
Speaker: Robert Gluckman, MD, Internal Medicine Specialist, Chief Medical Officer, Providence Health Plans

Objectives: 1) Understand the risks and benefits of the new Herpes Zoster vaccine 2) Apply the new ACC/AHA Hypertension guidelines 3) Understand the benefits and cost difference of insulin analogs vs. human insulin 4) Understand the risk of screening colonoscopy findings to determine recommendations for interval exams.

Handouts: CME_092118_Gluckman_Updaterevised

September 14, 2018 - "Proactive Management of Prediabetes"
Speaker: Stefan Bughi, MD, Associate Professor of Medicine, Division of Endocrinology, Keck School of Medicine of USC

Objectives: 1) Define prediabetes 2) List risk factors and clinical signs in individuals at risk for type 2 diabetes, including age, ethnic background, history of gestational diabetes, being overweight or obese, low physical activity, and a family history of diabetes 3) Identify interventions to modify risk factors in preventing type 2 diabetes 4) Develop a strategic management plan to proactively screen, assess, follow-up and evaluate patients with prediabetes, particularly prediabetes caused by insulin resistance.

Handouts: CME_091418_Bughi_Perm8893

September 07, 2018 - “Managing Subclinical Hypothyroidism"
Speaker: Linda Lester, MD, Associate Professor of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, OHSU School of Medicine

Objectives: 1) Identify which patients should be started on thyroid hormone therapy 2) Discuss types of thyroid hormone therapy currently being used, and identify recommended therapies 3) Identify how to monitor patients and adjust their doses to target an appropriate thyroid hormone level

Handouts: CME_090718_Lester_HOs_ManagingSubclinicalHypothyroidism

July 27, 2018 - “Techniques in Suicide Prevention”
Speaker: Laura Pennavaria, MD, Family Practice, Chief Medical Officer for St. Charles Medical Group

Objectives: 1) Increase understanding of the risk and protective factors associated with suicide 2) Learn culturally informed techniques for safety planning in the suicidal patient 3) Increase communication skills when interacting with patients at risk of suicide, their family members, and other care givers

Handouts: CME_072718_HOs_Pennavaria_SuicidePrevention

July 20, 2018 - TRAUMA CME “Pediatric Solid Organ Injury”
Speaker: Cindy Gingalewski MD, Medical Director, Pediatric Surgical Services, Randall Children’s Hospital

Objectives: 1) Identification of pediatric solid organ injuries 2) Practice guidelines for care of acutely injured child 3) Restrictions after acute injury of the child 4) Indications for safe transfer of care for the acutely injured child

Handouts: CME_072018_Gingalewski

July 13, 2018 - “Advances in Colon and Rectal Surgery”
Speaker: Phuong H Nguyen, MD - St. Charles Surgical Specialists

Objectives: 1) Review outcomes of minimally invasive surgery 2) Compare and Contrast Robotic Surgery and Traditional Surgery 3) Discuss surgical care of complicated colon and rectal pathology locally.

Handouts: CME_071318_Nguyen_NewTechniquesColorectalSurgery

June 29, 2018 - TRAUMA CME "Targeted Muscle Reinnervation for Upper Extremity Amputees with Myoelectric Prostheses"
Speaker: Albert Chi, MD Associate Professor of Surgery, Oregon Health & Science University

Objectives: 1) Identify patients who may benefit or be eligible for future myoelectric prosthesis use. 2) Explain the surgical approach to targeted muscle reinnervation for upper extremity amputees. 3) Describe the capabilities of the current and developing technology

Handouts: CME_062918_Chi

June 22, 2018 - “Intraoperative Neuromonitoring (IONM): How and Why”
Speaker: Jon Tippin, MD, FAAN, FACNS; Specialty Care partners for life, Nashville TN

Objectives: 1) Develop a basic understanding of IONM techniques and procedures. 2) Determine the predictive value of intraoperative changes in IONM data. 3) Apply this information to help determine which surgical procedures would be appropriate for monitoring.

Handouts: CME_062218_HOs_Tippin_IONM

June 15, 2018 - "Impact of Obesity in Primary Care and What To Do About It"
Speaker: Stephen Archer, MD, FACS, FASMBS, Director, Bariatric Surgery, St. Charles Medical Center

Objectives: 1) Recognize the role obesity plays in the pathogenesis and epidemiology of common problems such as diabetes, cancer, joint problems, depression, isolation and others. 2) Describe the impact of new medical treatments for treating obesity and some of their interactions and side effects. 3) Review bariatric surgery indications and results with respect to common ailments in a PCP practice. 4) Discuss prevention strategies as the ultimate answer to the obesity epidemic.

Handouts: CME_061518_ArcherImpactObesityPrimaryCarePracticeWhatodoaboutit

June 08, 2018 - "Talia's Voice"
Speaker: Dr. Jeff Goldenberg and Ms. Naomi Kirtner

Objectives: 1) Discuss strategies to advocate for patients’ care and safety. 2) List examples of communicating effectively with patients. 3) Describe the impact of ineffective communication on patient outcomes.

June 01, 2018 - "Dermatology Diagnostic Dilemmas - Common and Uncommon Challenges"
Speaker: Oliver J. Wisco, DO, FAAD, FACMS, Melanoma Specialist & Mohs Surgeon, Assistant Professor of Dermatology, Oregon Health and Science University

Objectives: 1) Understand the primary morphologic descriptors in Dermatology. 2) Understand the potential use of teledermatology to care for dermatologic issues. 3) Understand the importance of the differential diagnosis of cutaneous disease. 4) Understand the initial treatment approach to common and uncommon dermatologic conditions.

Handouts: CME_060118_Wisco_DermatologyDiagnosticDilemmasCommonUncommonChallenges

May 25, 2018 - No Grand Rounds - Memorial Day

May 18, 2018 - “Addressing Intimate Partner Violence with Patients”
Speaker: Jim Winkle, MPH

Objectives: The educational objective to address this gap is: "Apply universal screening for IPV and appropriate interventions in order to reduce patient morbidity and mortality." 1) Utilize appropriate questions that screen for IPV. 2) Explore an increased clinical index of suspicion with patients. 3) Perform an adequate safety assessment, safety planning, and documentation. 4) Review the research on the paradoxical effect of increased intimate violence when screening programs were initiated.

Handouts: CME_051818_Winkle

May 11, 2018 - “Participating in and Demonstrating Scholarly Activity for ACGME”
Speaker: Michele L. McCarroll, Ph.D., CCRP, ACSM-CCEP, FAACVPR, Chief Research Officer, Professor of Clinical Medicine, College of Osteopathic Medicine, Pacific Northwest University of Health Sciences

Objectives: 1) To review the process of conducting human subjects research. 2) To formulate a sequential process of answering a research hypothesis or quality improvement question by being exposed to both methodologies. 3) To implement proper methods of scholarly activity. 4) To apply a variety of acceptable ACGME qualifying scholarly activities 5) Increase comprehension of the focus areas of research being conducted in this area.

Handouts: CME_051118_McCarroll

May 04, 2018 - “Promoting Best Practices with Epic: Grouped Order Sets, and Overview of Nursing Standards of Care Guidelines and the impact on Providers”
Speaker: Mary Dallas, MD, Chief Medical Information Officer Clinical Informatics, St. Charles Health System

Objectives: 1) Introduce the concept of the OBSN and ANA guidelines for Nursing Standards of Care and articulate how the guidelines affect the daily workflow (how it relates to providers – what’s different). This is now part of orders in our Epic build, and this is why. 2) What are the bells and whistles of order entry? How clinical decision support is used in order entry to improve patient safety. 3) How grouped orders in order sets helps with promoting best practices. Insulin may be used as an example by show how this order set design translates into practice for administering insulin at the bedside, and resulting outcomes with hypoglycemic events related to insulin dosing.

April 06, 2018 - No Grand Rounds during April - Epic go-live

March 30, 2018 - No Grand Rounds - Spring Break

March 23, 2018 - "Comprehensive Care of the Transgender Individual"
Speaker: Christina E. Milano , M.D. Associate Professor of Family Medicine, School of Medicine OHSU

Objectives: 1) Improve participants' general competence in care of the Transgender and Gender Diverse Individual 2) Ensure understanding of the Medical and Mental Health needs of the Transgender Individual 3) Orient to available resources for ensuring best practices are applied in this realm

March 16, 2018 - TRAUMA "The General's Goiter: Outcome following a subtotal thyroidectomy on General George C. Marshall"
Speaker: Richard Mullins, MD, Professor of Surgery, Section of Trauma/Critical Care, OHSU; Captain, Inactive Ready Reserve, United States Naval Reserve

Objectives: 1) Review the influence of surgery on the patients whose principle ambitions are for an exceptionally consequential career 2) Discuss the role of thyroidectomy in management of subclinical hyperthyroidism 3) Review the technique of subtotal thyroidectomy as perfected by master surgeons in the first three decades of the 20th century 4) Discuss issues of patient confidentiality when the patient has public notoriety


March 09, 2018 - "Potassium Management Strategies: evidence from population and mechanistic studies"
Speaker: Joshua Kaplan, M.D. Assistant Professor of Nephrology Rutgers New Jersey Medical School

Objectives: 1) Review basic kidney anatomy/physiology. 2) Discuss the global epidemic of hypertension. 3) Identify the links between sodium, potassium and blood pressure. 4) Determine which intervention strategies might be most effective in reducing hypertension among your patient population. 5) Potassium Management in the hospital.

Handouts: CME_030918_Kaplan

March 02, 2018 - "Interpersonal Neurobiology – Improved Self Care to Improved Patient Care"
Speaker: Mary Meador, MD, Family Medicine Bend, OR ; Louis Cozolino Ph.D, Professor of Psychology Pepperdine University Malibu, CA

Objectives: 1) Identify and review interpersonal and intra-personal communication tools for use in physician practice. 2) Analyze concepts in neurobiology to improve efficacy of providers’ interpersonal and intra-personal communication skills 3) Illustrate how to improve interactions with patients and multi-disciplinary team members by practicing self-care techniques such as mindfulness, self-reflection, physical exercise and social interaction

Handouts: CME_030218_GR_MeadorCozolino

February 23, 2018 - “Preparing for Epic: Using Problem Based Charting to Optimize Care by Multiple Consultants”
Speaker: Frances McCabe, MD, St. Charles Medical Director Clinical Informatics; Matt Clausen, MD, St. Charles Family Medicine

Objectives: 1) Describe the rational for Problem based management and problem based charting compared to traditional methodology. 2) Define the elements of an appropriate problem list, and best practice for Problem List management. 3) Demonstrate the tools that will be available in Epic to leverage the hospital problem list to create concise and meaningful notes for attending’s and consultants.

Handouts: CME_022318_GR_McCabeClausen

February 16, 2018 - “Intraoperative Neuromonitoring (IONM): How and Why”
Speaker: Jon Tippin, MD, FAAN, FACNS; Specialty Care partners for life, Nashville TN

Objectives: 1) Develop a basic understanding of IONM techniques and procedures 2) Determine the predictive value of intraoperative changes in IONM data 3) Apply this information to help determine which surgical procedures would be appropriate for monitoring

Handouts: CME_021618_GR_Tippin

February 09, 2018 - TRAUMA “Surgical Lessons Learned During the Vietnam War and (24 years later) the Persian Gulf War”
Speaker: Harley D. Kelley, MD, Assistant Professor of Surgery, OHSU, retired, active duty general surgeon in both wars

Objectives: 1) Discuss key concepts of forward casualty care in the military, including a fast forward surgical unit. 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: CME_020918_GR_Kelley

February 02, 2018 - “New Peanut Allergy Prevention Guidelines Starting In Infancy”
Speaker: Ronald A. Simon, M.D. Head, Allergy, Asthma and Immunology Adjunct Member, Department of Molecularand Experimental Medicine The Scripps Research Institute, San Diego, CA, Assistant Clinical Professor of Medicine and Pediatrics

Objectives: 1) Pathophysiology of peanut allergy 2) Diagnose and test for food allergies, including peanuts 3) Discuss the history of peanut allergy treatment in America 4) New LEAP Guidelines

Handouts: CME_020218_Simon_FoodAllergyPreventionandTreatment

January 26, 2018 - “Principles of Conservative Prescribing”
Speaker: Gregory L. Holmquist, Pharm.D., CPE, Palliative Care Strategies, Everett, WA

Objectives: 1) Think beyond drugs (consider nondrug therapy, treatable underlying causes, and prevention); 2) Practice more strategic prescribing (defer non-urgent drug treatment; avoid unwarranted drug switching; be circumspect about unproven drug uses; and start treatment with only 1 new drug at a time); 3) Maintain heightened vigilance regarding adverse effects (suspect drug reactions; be aware of withdrawal syndromes; and educate patients to anticipate reactions); 4) Exercise caution and skepticism regarding new drugs (seek out unbiased information; wait until drugs have sufficient time on the market; be skeptical about surrogate rather than true clinical outcomes; avoid stretching indications; avoid seduction by elegant molecular pharmacology; beware of selective drug trial reporting); 5) Work with patients for a shared agenda (do not automatically accede to drug requests; consider nonadherence before adding drugs to regimen; avoid restarting previously unsuccessful drug treatment; discontinue treatment with unneeded medications; and respect patients' reservations about drugs); 6) Consider long-term, broader impacts (weigh long-term outcomes, and recognize that improved systems may outweigh marginal benefits of new drugs).

Handouts: CME_012618_HolmquistG_Conservativeprescribing

January 19, 2018 - "Minimally-Invasive, Non-Opiate Treatments for Chronic Pain: New Frontiers in Neuromodulation"
Speaker: Robert Heros, MD, Spinal Diagnostics Tualatin, OR

Objectives: 1) Understand the differences between nociceptive and neuropathic pain 2) Identify patients presenting with complex neuropathic pain including Complex Regional Pain Syndrome 3) Identify indications for neuromodulation 4) Know how and where to refer these patients for appropriate treatment

Handouts: CME_011918_HOs_MinimallyInvasiveNonOpiateTreatmentsforChronicPain_Heros

January 12, 2018 - "Stroke through the Ages"
Speaker: Steven Goins, MD, Pacific Crest Neurology and St. Charles Stroke Program Medical Director

Objectives: 1) Identify the physiology of cerebral perfusion in infancy and discuss how this has impact on the occurrence of stroke in later life. 2) Recognize causes of stroke in childhood and young adults and discuss how these disorders continue as stroke causes throughout life. 3) Address economic impact of stroke in Oregon and nationally 4) Address the changing incidence of strokes in young adults and the implications for the future.

Handouts: CME_011218_StrokethroughtheAges2018_Goins

January 05, 2018 - No Grand Rounds - winter break