OHSU Partners: Clinical Integration in Action

Fred Williams, M.D. has been a Neurosurgeon at Tuality Healthcare for over a decade. In that time, he hasn’t had a partner to collaborate with – until now. Tuality and OHSU are now formally linked through OHSU Partners. With that collaboration has come a partnership between Dr. Williams and Jeremy Ciporen, M.D., an OHSU assistant professor in neurological surgery, that is serving both of them – and their patients.

Tuality Healthcare is a nonprofit, community-based organization serving a market area of 350,000 and growing. The neurological affiliation between Tuality and OHSU is an example of an integration of the organizations’ clinical services. As the state’s only public academic health center with over 15,000 employees, OHSU’s size contributes to its ability to provide many services and community support not found anywhere else in the state.

Partnership in action             

Chief Medical Officer of Tuality Healthcare, Stuart Currie, M.D., believes that the affiliation with OHSU “represents a giant leap for the academic medical center to reach into the community and bring the expertise that they offer back to the community for a lower cost of care and at the same time, adding the strength of OHSU to a community hospital like Tuality to enhance our ability to continue to provide for our community.”

photo by Jeff Schilling/Tuality Healthcare

OHSU enables Tuality to “offer more neurosurgical care for our patients at the same time we’re bringing a higher level of complexity of care out to Tuality that we would not be able to do without such a close affiliation with OHSU” says Dr. Currie.

Dr. Ciporen, for his part, is thrilled to be working alongside Dr. Williams.

“I feel pretty blessed that it was Dr. Williams who I was paired with,” he said. “There is a lot of mutual respect and he’s an accomplished neurosurgeon and he’s just a great individual. There’s a lot that I’ve learned already, there’s a lot to be learned. I think we match up well. I think we have a symbiotic relationship. I also think our skill sets complement each other.”

Dr. Williams is proud of the neurological care Tuality has always offered, and he also sees the added value that Dr. Ciporen brings to Tuality.

“He’s really brought us up to the forefront in neurosurgery,” Dr. Williams said “Not just up to standard – we were living up to standard before – but he’s moved us beyond that.”

Dr. Currie says Dr. Ciporen enables Tuality to establish a neurosurgical program in western Washington County that can care for more patients and more complex cases.

“Dr. Williams has been practicing in the community for a number of years, and we needed more capacity in neurosurgery. A great sign of our new affiliation is OHSU happened to have a neurosurgeon who had an interest in working in a community setting and bringing his expertise,” Dr. Currie said.

Team Effort                

Dr. Ciporen said the collaboration has been a team effort by all involved with patient care prioritized throughout.

“I’ve been really impressed by the patient-centric nature of the people at OHSU that I work with every day and also by the people and caregivers and administration at Tuality,” he said. “I’ve also been impressed by how many people have mobilized and actually did what they said they were going to do to make things happen.”

Dr. Williams said he appreciates that OHSU sets a high standard, just as Tuality does. He believes that the affiliation will continue to benefit both institutions.

“If we look into the future, there’s going to be a need for a major hospital facility here,” Dr. Williams said. “We’re going to be doing the things that we’ve always done, and we do those very well, but we’re going to have to think about expanding what we can do so that we can handle more things. They can’t all be done up on the hill at OHSU. We need capability out here.”

Dr. Ciporen adds “we’ve approached it not just as a neurosurgeon going there to do more volume but to improve access in the outpatient setting and the inpatient setting and in the multidisciplinary care setting. And I think that’s where the future is going to be as well.”

 

 

 

 

Small town collaborations, big health dividends

National Rural Health Day is November 17. OHSU celebrates rural communities and rural health care providers everywhere. Meet a few rural Oregon providers – OHSU graduates – in the story below. Find how OHSU faculty and students are joining forces with rural communities to strengthen local care.

By Rachel Shafer and Erin Hoover Barnett

Alumni, faculty and students join forces with rural communities to strengthen local care 

The elderly woman arrived at the small emergency room with rib fractures and a collapsed lung. Jessica Carlson, M.D. ’11, inserted a chest tube and stabilized her, while thinking ahead to next steps. Dr. Carlson is one of two general surgeons covering the Level 4 trauma center at Curry General Hospital in Gold Beach, Ore., a community hospital serving the 22,000 residents of Curry County along Oregon’s remote South Coast.

OHSU Bridges Magazine -- Dr. Jessica Carlson (cq) OHSU grad 2011 is the new surgeon at Curry General Hospital in Gold Beach, Oregon. © 2016 Fred Joe / www.fredjoephoto.com

OHSU Bridges Magazine — Dr. Jessica Carlson (cq) OHSU grad 2011 is the new surgeon at Curry General Hospital in Gold Beach, Oregon. © 2016 Fred Joe / www.fredjoephoto.com

Knowing the patient’s high risk of contracting pneumonia and the hospital’s limited capacity for critical care, Dr. Carlson concluded: LifeFlight to OHSU. She remembers the patient’s response: “I don’t want to go up there because if I die, I’ll be by myself. If I’m going to die, my family is here.”

So Dr. Carlson and the nursing staff sprang into action, pulling a ventilator and telemetry and suction equipment into a room adjacent to the nursing station to create a temporary ICU. With the help of a respiratory therapist and nurse with critical care experience, they cared for the woman over several days and released her, much recovered, to her family.

It’s outcomes like this one that reinforce why Dr. Carlson practices rural surgery in Gold Beach and why she carves out time to teach OHSU medical students on rural rotation. Rural providers matter.

Across Oregon, communities big and small are grappling with systemic changes in health care. But rural medicine faces additional challenges: limited local resources in equipment, staffing and specialty expertise; patient populations with higher mortality and low birthweight rates, according to Oregon Health Authority; a continual thirst for providers; and long travel times – in some cases, a six-hour drive to specialized treatment.

For decades, OHSU School of Medicine has worked in Oregon’s small communities through its volunteer faculty, rotating students, residents, community researchers and, importantly, practicing alumni physicians and physician assistants.

In recent years, though, school leaders took stock of the school’s rural mission, saw room for improved collaboration and are now doubling down on efforts. Why? The aim is not to thrust an academic health center onto local providers, who are the experts for health care in their communities. Rather, it’s to support community-led collaborations and relationships, deploying OHSU resources to fill gaps where needed and partnering with local providers to improve the health of their communities.

“When your mandate is to improve the health of Oregonians, you don’t get there by bringing everyone to Portland,” said Mark O’Hollaren, M.D. ’80, OHSU vice president for strategic outreach. “OHSU’s resources are finite, but we have been able to partner with a number of rural communities to improve access to care closer to home, conduct community-based research reflecting the needs and conditions of all Oregonians and help seed the next generation of rural providers through education and training programs far from the Portland metro area.”

 “A little piece of home”

Jane Johnson had at least one bit of good news when she woke up from her colonoscopy. She’d be able to stay in her North Coast community for much of her cancer care.

Driven by need a decade ago, the mayor of Astoria and leaders of the medical community reached out to OHSU, and together they’ve launched a series of collaborations that bring physicians at Columbia Memorial Hospital and OHSU together. The arrangement means that, in many more instances, medical care and procedures can be performed at Columbia Memorial Hospital. For Johnson, it means seeing her oncologist in Astoria as well as getting her chemotherapy port installed at Columbia Memorial Hospital by Rachel Van Dusen, M.D., assistant professor of surgery in the OHSU School of Medicine.

Then, when Johnson needed major surgery to remove her tumor, Dr. Van Dusen met her in the operating room at OHSU. Seeing Dr. Van Dusen before her surgery, Johnson said, “was like having a little piece of home.” Follow-up care has been in Astoria, including a recent visit with Dr. Van Dusen to discuss additional surgical procedures.

Dr. Van Dusen and Columbia Memorial Hospital leaders note that the focus needs to be on the providers – from CMH and OHSU – doing as much as they can at the community hospital; the collaboration should not become a one-way ticket to doing more procedures at OHSU.

The arrangement also benefits the local hospital and economy in other ways. Erik Thorsen, CEO of Columbia Memorial Hospital, says the hospital has grown by more than 15 physicians and estimates the economic ripple at 150 jobs in the community.

“It’s been a rewarding thing to watch the organization – and our community – grow,” said Thorsen, who grew up on the North Coast. “The community also sees value and takes pride that OHSU is here and that CMH is increasingly associated with the quality of OHSU.”

In addition, the arrangement means that physicians drawn to rural health care who also want the professional experiences possible in an urban medical center can have both. For Dr. Van Dusen, the collaboration with OHSU that her stepfather, longtime Mayor Willis Van Dusen helped convene, clinched her decision to practice in the town where she grew up.

“I didn’t think I could find a position I loved and do the surgery I wanted to do,” Dr. Van Dusen said. “This affiliation with OHSU came up, and it worked out perfectly.”

The Astoria clinical collaboration is just one of dozens playing out across the state, including those affiliated with the OHSU Telemedicine Network. Using secure, two-way video and audio communications, the network gives providers in community hospitals throughout the region immediate access to OHSU specialists, improving patient outcomes, avoiding unnecessary transports and helping rural Oregonians get well in their home communities.

Easing stress

Family physician Jon Schott, M.D. ’96, sees patients in the town where he grew up: Baker City, Ore., pop. 9,828, nestled in the mountain and sagebrush country of northeastern Oregon. Dr. Schott first began practicing there in 1999. “I had no business background, and coming out of residency into a frontier area felt – despite great training – completely overwhelming,” he said. “Connecting to OHSU was a survival mechanism.”

That connection was and continues to be L.J. Fagnan, M.D. ’71, professor of family medicine in the OHSU School of Medicine. Dr. Fagnan describes himself as a former country doc-turned community organizer. He logs significant “windshield time” attending meetings with rural, primary care practitioners around the state as director of the Oregon Rural Practice-based Research Network.

ORPRN staff provide technical assistance and quality improvement resources to aid in practice improvement. They disseminate best practices among clinics. They deliver education and skills training to help practices become medical homes. And they conduct research, investigating clinical questions in partnership with rural providers – linking questions from primary care practices to answers from practices.

In Baker City, an early project with ORPRN involved partnering with Baker City’s health department to increase pediatric immunization rates. “That led to not only increased rates in our area, but to a partnership that still exists today, which has grown from immunizations to include women’s health issues and a clinic located in the high school,” explained Dr. Schott.

ORPRN’s approach is not to tell rural providers what to do, but to facilitate and provide resources that enable practices to innovate and improve on their own. “It’s a stressful time in medicine,” said Dr. Fagnan. “We want to ease the stress on practices.” That’s the job of OHSU employee Steven Brantley, M.P.H., who is based in Ashland. A practice enhancement research coordinator, Brantley works full-time on Healthy Hearts Northwest, a federally funded project coordinated through organizations like ORPRN that help small- to medium-sized primary care practices build a quality improvement structure, while also working on improved heart health outcomes.

On a bright, fall morning, Brantley is in Klamath Falls, leading a meeting with providers and clinic managers at Cascades East Family Medicine. The discussion revolves around progress on the clinic’s smoking cessation efforts. Data are reviewed, survey results examined, problems and ideas aired. There is an easy banter in the room, but also an urgency from clinic staff. Patient health is at stake. Cascades East is doing good work, observes Brantley. “I want to take what they’re doing and share it with everybody else because it’s effective,” he said.

The needs of rural providers are as different as the communities they serve. ORPRN’s knack is to find commonalities and nurture solutions. “It’s my firm belief,” said Dr. Schott, “that our clinic in Baker City wouldn’t exist if not for our relationship with ORPRN.”

Skin in the game

The enormous topographical state map hanging on the wall in the office of Paul Gorman, M.D., keeps this assistant dean for rural medical education in the OHSU School of Medicine focused on his goal: place more medical students into more specialties completing more clinical experiences with more rural physicians across Oregon to increase the number of graduates entering rural practice. Currently, 350 alumni out of 2,276 total physicians practice in rural Oregon.

Dr. Gorman is the first leader in the school’s administration dedicated solely to rural medical education. “School leaders recognize the importance of rural medical education as a keystone to the school’s mission to serve all of Oregon, and we’ve redoubled our commitment,” said Dr. Gorman. “We know this is not a short-term effort. We are in it for the long haul.” Moreover, he added, it’s not what communities can do for the school but what the school can do for communities.

Dr. Gorman began his career in rural medicine. Over the years, he’s seen it change. “In all but the smallest towns, there is more technology and specialty care available than a generation ago,” he said. Rural medical education must also adapt by diversifying the spectrum of specialties available to students, Dr. Gorman says. Completing a rural clinical experience was and continues to be a requirement of the school’s M.D. curriculum. In fact, the school’s new curriculum, YOUR M.D., expands this by offering students the choice to experience an array of rural careers. Curious about rural cardiology? Rural emergency medicine? Rural surgery? Students can now sample specialties during rural rotations as well as the broad-based practice of primary care.

Dr. Gorman is the first to acknowledge the school needs to do a better job of strengthening relationships with rural communities and providers.

The school is also challenged to promote rural medicine to M.D. students from within the environs of Portland. But that’s where Nick West, Abbie Huddleston and Emily Thompson come in. Second-year medical students hailing from Imbler, Seaside and Heppner, respectively, they’re passionate about returning to rural Oregon. All of them participate in the state’s Scholars for a Healthy Oregon Initiative, in which the state provides funding for student tuition and fees in exchange for a commitment to practice in a rural and/or underserved area for a given period.

During their first year, the trio wondered why there weren’t more rural activities in the new curriculum. So they set out to fix it. With Dr. Gorman’s help, they launched the Rural Medicine Discovery Program. Between course blocks, any M.D. student can sign up to take enrichment trips to rural communities around the state. There, they precept with a physician, eat dinner with local practitioners to get a feel for the provider network, talk to local high school students about health care careers and enjoy activities such as surfing, visiting museums or biking through the countryside. The trips have become popular with M.D. students. Sign-ups feature waiting lists, and the three have heard from fellow classmates who have become “stoked about rural medicine,” as West put it.

The idea is to ground students in real experiences so they can envision all that a rural commitment entails, the three say. “Rural people distrust the health care system when they have transient physicians,” said West. “Small communities want longitudinal health care, whether that’s the cardiologist, surgeon or family physician.”

West, who grew up on a cattle ranch, added, “We need physicians who are riding for the brand, so to speak. They need to have skin in the game. Rural physicians need to be there, regardless.”

Small town life

Dr. Jessica Carlson of Gold Beach is invested. She’s wanted to live and work on the Oregon Coast ever since rotating in Florence, Ore., as an OHSU medical student. She bought a house in Gold Beach and has joined local clubs. She’s planning outreach activities to local K-12 students. She shops at local businesses. And at work, she considers herself more than just a surgeon. Her personal mission these days is preventive care such as mammograms, she says, because she’s performed a lot of breast cancer surgery on Curry County women. Every woman of a certain age who comes to her clinic now gets a mammogram, she says. If they express hesitation or anxiety about it, Dr. Carlson walks them over to the hospital and sits with them to give them support.

During a break between patients in the small, florescent-lit office she shares with a fellow surgeon, this rural doctor reflects on her definition of success.

“What do I need to do to improve health care as a whole for this community? That’s my job. My job is not to take out a bunch of gallbladders and fix some hernias, and say, ‘Thanks, it’s been fun.’ My job is to look at how I can improve people’s health. If I can provide care for them here, it’s better for them and better for our community.”

New OHSU Campus for Rural Health

Last year, OHSU launched a new university-wide initiative to better support the diverse, health needs of rural Oregon. The OHSU Campus for Rural Health, with academic headquarters in Klamath Falls, is comprised of distributed, learning sites around the state where OHSU medical, dental, nursing, pharmacy and physician assistant students live and learn together.

Students gain valuable, interprofessional experiences in rural clinical settings while immersing themselves in local health issues by participating in a longitudinal, community-based project. Current sites are located in Klamath Falls and Coos Bay, and OHSU is exploring possibilities for a new site elsewhere in the state.

The initiative builds on existing concentrations of OHSU resources and programs around the state to formalize and strengthen learning and teaching outside the Portland metro area.

Studies show that exposing more students to rural areas will directly affect how many people go into rural practice, says Joyce Hollander-Rodriguez, M.D. ’00 R ’03, regional associate dean for the Klamath Falls site. “And even if they don’t go into rural practice, they will apply that knowledge when they see rural people in urban settings.”

Another goal of the sites is to provide organized professional development and training for local practitioners who are teaching OHSU students. “In transforming students into strong, interprofessional providers, we are also transforming ourselves into better providers,” said Dr. Hollander-Rodriguez.

To meet facility needs in Klamath Falls, OHSU and Sky Lakes Medical Center are joining together on the construction of a collaborative health care building.

 

Moving forward: A message from OHSU President, Joe Robertson

This week’s presidential election has caused a sense of vulnerability and concern about the future. The heated and, too often, hateful rhetoric that punctuated the campaign season has made the results of this election feel very personal for many.

In several cities, including Portland, this has led to protests that in some cases have become violent, a response that is never constructive and counter to our core values as healers. At times like these we must remember and reaffirm our core values as an institution — particularly our commitment to diversity, equity and inclusion. We must remain steadfast in our drive to be a great organization, diverse in people and ideas.

We are a community of people dedicated to healing — and sometimes that includes healing each other. We need to learn from this experience and help each other and our community to engage in healing and healthy dialogue. Part of the healing process must involve taking positive action.

The results of this week’s election have also left many of us thinking about the future of health care in our nation and the impact on our mission of improving the health of all Oregonians. I can assure you that we will continue to work with state and federal leaders to advocate for the quadruple aim and for access to health care for all.

There may be changes to public policy that impact the work we do. As these proposals are detailed in the coming weeks, we will have additional discussions about what this means for our institution. In the meantime, let’s continue the important work that we are doing today.

In this time of change and disruption, I encourage each of you to take time for yourself, your family and find strength in how we serve and care for one another.

This message originally appeared in a Directline email to staff from OHSU President, Dr. Joe Robertson

NIH Director Collins ignites optimism and collaboration during campus visit

National Institutes of Health Director Francis Collins, M.D., Ph.D., spent a day at OHSU sprinkling some fairy dust of possibility that is spurring renewed optimism and new grant applications to fuel the next generation of science at OHSU.

Dr. Collins visited on Monday, Oct. 24 to give the 2016 Mark O. Hatfield Lecture, named for his personal mentor, the late U.S. Senator Mark Hatfield. Dr. Collins’s standing-room-only evening lecture at CLSB – “Exceptional opportunities in biomedical research” – pulled together the narrative he built over the course of the day in small group sessions with faculty, partners, elected officials and students.

It was a narrative about hope.

After a dozen years of declining grant funding, the fever chart is inching up.

(Left to right) John Hunter, M.D., F.A.C.S., interim dean for the School of Medicine and National Institutes of Health Director Francis Collins, M.D., Ph.D. walk across the OHSU campus October 24, 2016. Dr. Collins met with OHSU leaders, learned about OHSU research and toured facilities prior to delivering the Mark O. Hatfield Lecture in the evening. (OHSU/Kristyna Wentz-Graff)

(Left to right) John Hunter, M.D., F.A.C.S., interim dean for the School of Medicine and National Institutes of Health Director Francis Collins, M.D., Ph.D. walk across the OHSU campus October 24, 2016. Dr. Collins met with OHSU leaders, learned about OHSU research and toured facilities prior to delivering the Mark O. Hatfield Lecture in the evening.
(OHSU/Kristyna Wentz-Graff)

The NIH’s BRAIN Initiative and the Cancer Moonshot, led by Vice President Joe Biden, are directing national focus to the frontier of basic science – the brain – and a scientific pursuit which now feels within reach: curing cancer.

Failure to diversify the ranks of scientists has led to renewed determination, recognizing that attracting multiple perspectives to ask new questions and perceive new solutions is central to advancement.

And NIH has launched the All of Us Research Program – with the goal of signing up 1 million people across age, race and class to fuel population health studies that can tailor treatments to individuals, rekindling patriotism of a nonpartisan nature akin to putting man on the moon.

Yet the sense of possibility his visit engendered came not only from his marketing of NIH but in the ways he engaged faculty, partners and students and in the ways that OHSU used his visit as a catalyst.

A catalytic visit

OHSU President Joe Robertson, M.D., M.B.A., and research leaders welcomed Dr. Collins with a luncheon discussion about the OHSU-Intel Cancer Cloud Collaborative. The conversation included OHSU School of Medicine faculty members Drs. Brian Druker, Joe Gray, Adam Margolin and Lisa Coussens;* U.S. Senator Ron Wyden and Rep. Earl Blumenauer; PSU’s Erin Flynn, board chair of Oregon Inc.; Intel leaders; and Eric Dishman, formerly of Intel and now leading the All of Us Research Program for NIH.

Their discussion about a cloud of clouds — that allows researchers to bring their computers to the data rather than ginormous data sets to their computers  helped define for Dr. Collins how OHSU can contribute to the big data dilemma NIH must tackle to realize the promise of the All of Us precision medicine initiative.

“This is an industrial challenge of the first order,” said Dr. Gray, associate director for translational research at the Knight Cancer Institute. “Oregon has a confluence of people interested in the data and people interested in the application.”

Showcasing basic science

An hour-long research forum followed with teams from cancer, infectious disease and neuroscience presenting their work to Dr. Collins, who listened intently.

“If Zika has been around for decades in Africa, why didn’t we know it had this impact during pregnancy?” Dr. Collins asked, sparking a discussion following a presentation on the virus by maternal-fetal medicine specialist Antonio Frias, M.D., associate professor of obstetrics and gynecology, OHSU School of Medicine.

National Institutes of Health Director Francis Collins, M.D., Ph.D. listens to presentations about key areas of research being conducted by OHSU, as he visited campus on October 24, 2016. Dr. Collins met with OHSU leaders, learned about OHSU research and toured facilities prior to delivering the Mark O. Hatfield Lecture in the evening. (OHSU/Kristyna Wentz-Graff)

Bita Moghaddam, Ph.D., incoming chair of behavioral neuroscience, joins in a discussion with Dr. Collins during faculty presentations about research specialties at OHSU.

And as Marc Freeman, Ph.D., director of the Vollum Institute, wrapped up his slides on OHSU’s work in neuroscience from bench to bedside, Dr. Collins probed how OHSU is positioning itself to take advantage of the NIH BRAIN Initiative. Minutes after the session ended, Damien Fair, Ph.D., P.A.-C., associate professor of behavioral neuroscience and imaging leader, and Bita Moghaddam, Ph.D., incoming chair of behavioral neuroscience, and Carsten Schultz, Ph.D., new chair of physiology and pharmacology, huddled in the foyer to plan a cross-campus collaboration on a grant application.

Dr. Fair said Dr. Collins’s visit seeded “a blossoming of ideas of all we can do across the institution” while also pointing out areas for improvement, such as the need for engineering expertise within OHSU – not just through tech partners – to meet new challenges in translational science.

Caring about students

In a private session with 20 graduate students and postdoctoral fellows and during a question/answer period after his lecture, Dr. Collins delivered a chin-up message to trainees. He emphasized the areas where NIH is investing and offered thoughtful advice about staying flexible and choosing a research focus broad enough for a course correction if prospects in one area fizzle.

National Institutes of Health Director Francis Collins, M.D., Ph.D. (left) talks with Joe W. Gray, Ph.D. at the Spatial Systems Biomedicine October 24, 2016. Dr. Collins met with OHSU leaders, learned about OHSU research and toured facilities prior to delivering the Mark O. Hatfield Lecture in the evening. (OHSU/Kristyna Wentz-Graff)

National Institutes of Health Director Francis Collins, M.D., Ph.D. (left) talks with Joe W. Gray, Ph.D. at the Spatial Systems Biomedicine October 24, 2016. Dr. Collins met with OHSU leaders, learned about OHSU research and toured facilities prior to delivering the Mark O. Hatfield Lecture in the evening.
(OHSU/Kristyna Wentz-Graff)

Behavioral neuroscience graduate student Eileen Torres said Dr. Collins made her feel like NIH is in her corner, that the agency understands how the funding challenges impact budding scientists and has real plans for addressing the problem with strategic investment.

“It hasn’t been until now that I’ve heard any bright spots,” Torres said, “so it was nice.”

Dr. Collins rounded out the afternoon before his lecture with a tour led by Dr. Gray of the OHSU Center for Spatial Systems Biomedicine, one of OHSU’s newest tools for taking science at OHSU to the next level. He ended the evening with goodwill.

“I’ve had a great time today,” Dr. Collins said. “Everything I’ve heard and seen today says that OHSU is a great place. You’re big enough to do outstanding multidisciplinary work but not too big to run into too much bureaucracy. You’re in that sweet spot.”

*Particulars

Brian Druker, M.D., director, OHSU Knight Cancer Institute; professor of medicine, OHSU School of Medicine

Joe Gray, Ph.D., director, OHSU Center for Spatial Systems Biomedicine; professor of biomedical engineering, OHSU School of Medicine

Adam Margolin, Ph.D., director of computational biology and associate professor of biomedical engineering, OHSU School of Medicine

Lisa Coussens, Ph.D., associate director of basic research, OHSU Knight Cancer Institute; professor and chair of cell, developmental and cancer biology, OHSU School of Medicine

Jake’s story: A senior project from the heart

The Knight Cardiovascular Institute recently hosted a patient forum for over 60 patients with hypertrophic cardiomyopathy (HCM), a genetic heart condition. At the event attendees heard from experts about the latest treatments, lifestyle recommendations and research for HCM. They also heard from Jake Hansel, a senior at Camas High School recently diagnosed with apical hypertrophic cardiomyopathy. Jake’s senior project focuses on raising awareness of the disease and support for HCM research. Below, Jake shares his story.

My name is Jake Hansel and I am a senior at Camas High School. I love basketball and as a freshman I made the varsity basketball team. For two years, I was our starting point guard and we qualified for State for the first time in 51 years. Last fall my doctor recommended I have a routine EKG screening due to a family history of a heart condition. The EKG results were abnormal. After some additional tests, I was cleared to play my junior year but told that I would need to have follow-up tests in March. At the completion of my junior year, I was selected to First Team Class 4A Greater St. Helen’s All-League as well as second team All-Region.

Jake and Dr. Heitner

Jake with Dr. Stephen Heitner, Director of the Hypertrophic Cardiomyopathy Clinic at OHSU

After my junior year, I was in contact with several colleges and had hopes of continuing both my athletic and academic career. Basketball, strength training, and conditioning had always been a major part of my daily life with my academics. I have maintained a 3.99 GPA.

In March after extensive tests, I was diagnosed with apical hypertrophic cardiomyopathy. I was told I could no longer play competitive sports. Hypertrophic cardiomyopathy (HCM) is a genetic condition where part of the heart muscle is enlarged. The enlarged portion can be less effective than normal heart muscle, leading to symptoms like shortness of breath, lightheadedness, fainting, chest pain and palpitations. In rare, severe, cases it can lead to an abnormal or rapid heart rate, which can be fatal.

An estimated 1 in 500 people have the disease, yet not much is really known. There are treatment options that can provide improvements in quality of life for many with HCM, but there is no cure at this time. I recently met with Dr. Stephen Heitner, the Director of the Hypertrophic Cardiomyopathy Clinic at the OHSU Knight Cardiovascular Institute. They are conducting very exciting research into new treatment options for HCM that will hopefully eradicate this disease entirely.

My goal is to raise awareness about HCM and raise money for research into treatments of the disease.

***

Jake will be hosting a fundraiser at Camas High School on January 17 during the varsity basketball game against Skyview High School. If you would like to get involved, the OHSU Foundation is accepting donations on his behalf to be directed towards HCM research. You can make a donation online at http://support.ohsufoundation.org/HRTM17A

OHSU students, staff and faculty join leaders in committing to address gun violence as a public health issue

OHSU leaders, faculty, staff and students gathered in the late afternoon rain outside Mackenzie Hall Tuesday, Oct. 4 to mark an institution-wide commitment to address gun violence as a public health issue.

“We all know why we are here,” OHSU President Joe Robertson, M.D., M.B.A., told the gathering of more than 100. “We are troubled by the increasing violence in our society and the way in which that violence has disproportionately impacted people of color. As an institution, OHSU has struggled a bit to finds its voice. As healers, we want to act, but we must do so in a way that is consistent with our mission and also respectful and inclusive of those who have been involved in this issue for much longer. Now I think we have the right man to help us find our voice.”

Dr. Robertson introduced Brian Gibbs, Ph.D., vice president for Diversity and Inclusion and a faculty member in the OHSU-PSU School of Public Health. In July, Dr. Robertson charged Dr. Gibbs with leading a series of community conversations to identify how OHSU – across its clinical, research and education missions – can best address gun violence as a public health issue. His directive was inspired by calls for action by students, staff and faculty.

The Center for Diversity and Inclusion and the School of Public Health have now convened the Gun Violence as a Public Health Issue Advisory Committee to plan community forums to identify opportunities for OHSU and community partners to reduce gun violence and address the social and societal conditions that contribute to it. The advisory committee met for the first time at 9 a.m. on Oct. 4. The Stand Together vigil at 5 p.m. kicked off the work.

Faculty, employees and students of OHSU came together in a display of unity against gun violence at an event on Tuesday, October 4, 2016 at the Mackenzie Hall fountain.  (Oregon Health & Science University/Kristyna Wentz-Graff)

Faculty, employees and students of OHSU came together in a display of unity against gun violence at an event on Tuesday, October 4, 2016 at the Mackenzie Hall fountain.
(Oregon Health & Science University/Kristyna Wentz-Graff)

“Tonight we shift from a place where we were standing as individuals to a place where we stand in unity,” said Dr. Gibbs, who was joined at the event by the provost and the deans of all the schools. “There has been a great amount of work from many parts of the institution to help make this day possible. However, the harder work is ahead of us. But to get there we first had to stand and then step out onto the path together.”

The event was defined by personal reflections from three students – Kalisha Bonds, a Ph.D. candidate in the School of Nursing; Brianna Ennis, M.D. ’19, and Alisha Berry, M.D. ’19 and a co-leader of Students for LGBTQ Health.

Ms. Ennis read a poem she wrote.

“Oscar Grant, Trayvon Martin, Michael Brown, Eric Garner,

Tamir Rice, Eric Harris, Walter Scott, Alton Sterling,

Philando Castile, Keith Lamont Scott, Terence Crutcher,

I will stop here; You already know where I’m headed.

May the beautiful black men robbed of their freedom, their dignity, their hopes and dreams—

May they rest in peace.

I’m angry; I’m pained. This is an understatement—

It’s more like my cup runneth over with bitterness and rage.

Faculty, employees and students of OHSU came together in a display of unity against gun violence at an event on Tuesday, October 4, 2016 at the Mackenzie Hall fountain.  (Oregon Health & Science University/Kristyna Wentz-Graff)

Brianna Ennis, M.D. ’19, shared a poem she wrote as a call to action to acknowledge and address how racism plays into health disparities, including the likelihood of being shot by police or others.

But most of all I fear.

I fear for my dad, my brother, my future son. Any one of them could be next.

And I am not immune; I fear for myself too…

We are called today to stand together as healers,

to throw compassion at darkness and rise to the light,

and to practice what we preach.”

Alisha Moreland-Capuia led the crescendo and finale of the event.

Assistant professor of Psychiatry and executive director of the OHSU Avel Gordly Center for Healing, Dr. Moreland-Capuia completed her psychiatry residency and addiction psychiatry fellowship at OHSU. She is serving on the Gun Violence as a Public Health Issue Advisory Committee.

Dr. Moreland-Capuia called the participants to the moment, defined and underscored the importance of the work and then invited everyone to turn toward the Mackenzie Hall fountain and join hands.

As the rain clouds momentarily parted to reveal a sliver of blue sky, orange-, red- and yellow-colored lights illuminated the Mackenzie Hall fountain. The lights remained on all night as a beacon of the institution’s commitment.

After the vigil, Molly Rabinowitz, M.D. ‘18, stood with classmates sipping hot chocolate provided for the event. Ms. Rabinowitz is among a group of inter-professional students that began calling for OHSU to act in the midst of police shootings of unarmed black men starting in 2014 and signed on to a letter to the OHSU administration.

“Across our classes and our university, students didn’t feel that the administration was listening to our concerns about issues of institutional racism and social justice,” Ms. Rabinowitz said.
“Now we’re here. This vigil and the work that will follow is both exactly what we wanted and so much more than we expected. We finally feel heard, and that brings me so much hope.”

 

Follow the work at www.ohsu.edu/standtogether .

 

(all photos courtesy of OHSU/Kristyna Wentz-Graff)

OHSU nurse midwives celebrating National Midwifery Week 2016

National Midwifery Week is supported by ACNM, its members, physicians, and women’s health organizations across the nation.

OHSU has a thriving faculty midwifery practice. OHSU’s midwifery graduate program has been ranked as one of the top Midwifery programs from U.S. News & World Report consistently since 2004.

Some of our faculty include:

  • Sally Hersh,D.N.P.,C.N.M. who received the Excellence in Teaching Award for graduate teaching chosen by the OHSU School of Nursing students. Sally teaches core coursework in the graduate nurse-midwifery academic program, precepts masters’ degree midwifery students in the busy faculty practice, and supervises DNP students during their final year of doctoral work.

  • Michele Megregian N.M., M.S.N., who published Ethics Education in Midwifery Education Programs in the United States
  • Ellen Tilden, Ph.D. Most recently The Wall Street Journal picked up her team’s research regarding the influence of group prenatal care and timing of hospital admission. She received the 2016 Early Career Achievement Award from the OHSU School of Nursing Alumni Association. Dr. Tilden’s current work includes examining the risks and benefits of giving birth inside and outside a hospital setting and she received broad media attention following her publication in The New England Journal of Medicine. Dr. Tilden’s work is supported by a National Institutes of Health-funded BIRCWH K12 award made possible through the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Research on Women’s Health.
  • Retired faculty and midwife Carol Howe, an Elnora E. Thompson Distinguished Professor at OHSU, was presented with the 2016 Dorothea M. Land, Pioneer Award by the Certified Nurse Midwives Foundation, which honors exceptional certified nurse midwives who have exhibited vision and leadership. Carol is also the founding director of the OHSU Nurse-Midwifery Education Program. Carol dedicated over 35 years to educating midwifery students and practice in our clinic.

Our midwives have been caring for women across their lifespan since 1975. They educate the community on women’s health, including nutrition, sexual health, menopause and osteoporosis. OHSU midwives also offer prenatal care and provide compassionate, respectful and family-centered care. They also offer a water birth program that was established in 1997.

To learn more about becoming a Nurse-Midwife, please take a look at the OHSU School of nursing program pages.

To learn how to receive care from one of the OHSU midwives, please visit our website.

Food as medicine

By now, we’ve all heard the recommendations for a heart-healthy diet – reduce your saturated fat intake, avoid trans fats, cut back on salt. But did you know there are specific foods you can eat that can help lower your LDL (bad) cholesterol even further? Researchers have created a “portfolio” of cholesterol-lowering foods, that, when eaten together along with a heart-healthy diet, are even more effective at reducing LDL cholesterol than a low-saturated fat diet alone. Incorporate these four foods into your diet to maximize your heart health.

  • Soluble fiber – The two types of fiber, soluble and insoluble, are beneficial for a host of health issues, but getting at least 10 grams of soluble fiber every day is useful for reducing LDL cholesterol. Fiber is found in all whole plant foods such as fruits, vegetables, legumes, nuts, and grains; foods highest in soluble fiber include oats, barley, beans, citrus fruits, apples, okra, eggplant, and ground flax seeds. You can also take a fiber supplement made from psyllium husk (e.g., Metamucil).almonds
  • Soy – Aim for adding 25 grams a day of soy protein to help lower LDL cholesterol and reduce your risk of heart disease. Choosing more plant proteins, such as soy, in place of animal proteins helps reduce intake of saturated fat and cholesterol while increasing fiber. To get to 25 grams, aim for two servings of soy foods a day—examples of a serving include ½ cup shelled edamame, 1 cup soy milk, ½ cup tofu, 3 ounces tempeh, or a soy “burger” such as Boca Burger.
  • Almonds – This study looked specifically at eating ¼ cup of almonds every day (plain, not salted or honey-roasted), but the heart benefits of all nuts are well documented. Sprinkle them on your oatmeal, salad, or stir-fry, or simply eat a small handful as a snack.
  • Plant sterols and stanols – Plant sterols and stanols are naturally found in plant foods such as grains, legumes, nuts, and seeds, and are very effective at lowering LDL by blocking cholesterol from being absorbed into the bloodstream. The problem is that it’s impossible to eat enough plant foods (even for this dietitian!) to get to the recommended dose of 2 grams a day. Many foods have added plant sterols and stanols (such as Benecol and Take Control margarine or Minute Maid Heart Wise orange juice), but I prefer a capsule such as Nature Made CholestOff Plus (taken twice daily with meals). These supplements help to avoid the extra calories from fortified foods (it takes 4 tablespoons of Benecol spread to get to the recommended 2 grams of plant sterols – too much margarine, in my opinion!).

After years of hearing that we should eat less, I love being able to tell people that eating more of certain foods can improve their health. Enjoy!

***

Tracy Severson, R.D., L.D., is the dietitian for the Center for Preventive Cardiology at the Knight Cardiovascular Institute. She specializes in nutrition counseling for cardiovascular health and weight management.

 

Race for the Cure: Shirley’s story

For Shirley Ira, participating as a Race for the Cure team captain is both personal and professional: an experience that blends her many years coordinating care for oncology patients at OHSU Casey Eye Institute (CEI) with some personal losses.CEI Team

In 1991 the Susan G. Komen Foundation was about to launch its first Race for the Cure event in the Portland area and Ira had volunteered to be a team captain, representing CEI: at the time, she was the only clinic coordinator at CEI with oncology experience.

“You wouldn’t think an eye clinic would see patients with breast cancer.” Ira explained that sometimes breast cancer patients develop metastatic lesions in their eyes.

Over the years she has watched Portland’s Race for the Cure grow to what it is now: one of the largest in the country. Ira thinks the level of participation in the Northwest says a lot about the people here and their willingness to support a good cause that help others in their community. One of her favorite aspects of being a team captain is the opportunity it gives her to rally others to join the cause.

But the connection for Ira hasn’t been just professional. “I did lose a very good friend at one Race namestime.” In recent years several coworkers she’s been very close to at CEI have also been diagnosed with breast cancer. And most recently, one of CEI’s international fellows – a highly trained ophthalmologist who was here for two years for special training – died after returning home to Germany.

Ira shared a photo with us from last year’s race containing a list of names and a short message: “One of the reasons I participate! All the survivor names are coworkers at CEI.”

This year, she’ll walk in celebration of them, in memory of her friend and colleague, and in honor of her patients – some of whom will join her at the race on Sunday.

Shirley Ira is a clinic coordinator at OHSU Casey Eye Institute (CEI) where she coordinates care for adult and pediatric oncology patients with malignant tumors in their eyes. For over 17 years she coordinated patient enrollment and participation in an ocular oncology trial at CEI through the National Institutes of Health (NIH).

Support #TeamOHSU and post your pictures from the Race to Facebook, Twitter, or Instagram using #OHSUKnight.

Race for the Cure: a mother’s legacy

For Race for the Cure Team Captain Jill Mason, participating in the Susan G. Komen breast cancer fundraiser and outreach event in Portland each year is a family event inspired by a woman who is dearly loved and remembered.

After their mother, Cricket, died of breast cancer in the Spring of 1993, Mason and her sister rallied family members together to participate in the walk the followinRace for the Cure historicalg year. “Cricket’s Crew hasn’t missed a year since we started,” she said with a smile.

A photo from one of their first years shows Mason with her sister and daughters wearing their matching Race t-shirts, standing in front of a rock outside of Mason’s neighbor’s home.

Mason pointed to one of the young girls in the photo and chuckled: “her t-shirt was hanging down to her ankles – now it fits like a normal shirt!”

What began with just the women of the family quickly grew to what it is today: a multi-generational family reunion of sorts. Each year, brothers, sisters, cousins, and in-laws, travel, or sleep in, from across the country – some as far as Maryland, North Carolina, Iowa, and Idaho – to participate
in the walk.

Last year was their team’s biggest year yet with 29 participants. This year – the 25th anniversary of Race for the Cure in Portland – looks to be even bigger. And just like the early years, no team member is too small to participate: eight are three years of age and younger. The youngest, born just weeks ago, will be about two Race for the Cure teammonths old when he dons his pink Team OHSU t-shirt on September 18 in honor of his great-grandmother.

Before the walk begins however, the team will gather briefly for a picture in front of the same rock they’ve been photographed in front of for the past 22 years.

A faculty member in the OHSU School of Dentistry, Mason spends part of her time in clinic with students and patients. She also directs all community-based rotations – where students go work in public health and community clinics.

 Join #TeamOHSU and post your pictures from the Race to Facebook, Twitter, or Instagram using #OHSUKnight.

Why 96,000 Square Miles?

OHSU Health Fair at Pioneer Square.

President Robertson is fond of saying that OHSU has a 96,000 square mile campus, serving Oregonians “from Enterprise to Coos Bay, from Portland to Klamath Falls.”

This blog aims to highlight that breadth. 96,000 Square Miles (96K for short) will focus on the people of OHSU, the Oregonians we serve and the ripple effect of our work in Oregon and beyond.

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