Papers by Paula Termuhlen
Teaching Visual: Breast Pathology
Elsevier eBooks, 2009
Journal of Surgical Education, May 1, 2011
Thyroid Nodule in a 48-Year-Old Woman (Case 14)
Breast cancer screening and diagnosis in a community health system during the COVID-19 pandemic
Journal of Clinical Oncology, Jun 1, 2022
Journal of osteopathic medicine, Oct 1, 2016
H istorically, the Accreditation Council for Graduate Medical Education (ACGME) has accredited re... more H istorically, the Accreditation Council for Graduate Medical Education (ACGME) has accredited residency programs, and the American Board of Surgery (ABS) has certified surgeons. However, the ACGME and ABS have a collaborative relationship such that the ACGME holds ABS certification of program graduates as a key outcome measure for residency programs and their maintenance of accreditation. 1 For graduates of training programs approved by the American Osteopathic Association (AOA), the American Osteopathic Board of Surgery (AOBS) provides the pathway to certification for osteopathic surgeons. Through the Residency Evaluation and Standards Committee (RESC), the AOA monitors programs to ensure that qualified applicants are eligible to enter the AOBS process for certification, and board examination pass rate is a consideration of the RESC when reviewing program
Surgery in the older patient
PubMed, Feb 1, 2002
Surgery is still the most important treatment for solid tumors, regardless of the age of the pati... more Surgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients. Options for palliation are discussed. We conclude that older patients should not be deprived of curative surgery based on chronologic age alone.
American Journal of Public Health, Oct 1, 2020
We introduce "rural legal deserts," or rural areas experiencing attorney shortages, as a meaningf... more We introduce "rural legal deserts," or rural areas experiencing attorney shortages, as a meaningful health determinant. We demonstrate that the absence of rural attorneys has significant impacts on public health-impacts that are rapidly exacerbated by COVID-19. Our work builds on recent scholarship that underscores the public health relevance of attorneys in civil and criminal contexts. It recognizes attorneys as crucial to interprofessional health care teams and to establishing equitable health-related laws and policies. Attorney interventions transform institutional practices and help facilitate the stability necessary for health maintenance and recovery. Yet, critically, many rural residents cannot access legal supports. As more individuals experience unemployment, eviction, and insecure benefits amid the COVID-19 pandemic, there is a need for attorneys to address these social determinants of health as legal needs. Accordingly, the growing absence of attorneys in the rural United States proves particularly consequential-because of this pandemic context but also because of rural health disparities. We argue that unless a collaborative understanding of these interrelated phenomena is adopted, justice gaps will continue to compound rural health inequities.
Association of Demographic Factors and Medical School Experiences With Students’ Intention to Pursue a Surgical Specialty and Practice in Underserved Areas
JAMA Surgery, Dec 8, 2021
Importance The surgical workforce shortage is a threat to promoting health equity in medically un... more Importance The surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students' intention to practice in underserved areas is unknown. Objective To evaluate the association between students' demographics and medical school experiences with intention to pursue surgery and practice in underserved areas. Design, Setting, and Participants This cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020. Main Outcomes and Measures Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students' intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas. Results Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ2 P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas. Conclusions and Relevance This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students' motivation to practice in underserved areas.
PubMed, Mar 1, 2004
Context: Merkel cell carcinoma is an aggressive cutaneous tumor without clearly defined treatment... more Context: Merkel cell carcinoma is an aggressive cutaneous tumor without clearly defined treatment and high propensity for metastasis. Case report: This case describes a sixty four year old presenting with obstructive jaundice approximately two years after having a Merkel cell carcinoma resected from his finger. He underwent a successful pancreaticoduodenectomy with pathology confirming metastatic Merkel cell carcinoma. This report reviews the history, presentation, and current treatment recommendations for Merkel cell carcinoma. Conclusions: We propose that resection of metastases from Merkel cell carcinoma may confer a survival advantage and should be strongly considered, particularly if isolated.
Cancer Biology & Therapy, 2002
View related articles Citing articles: 22 View citing articles © 2 0 0 2 L a n d e s B i o s c i ... more View related articles Citing articles: 22 View citing articles © 2 0 0 2 L a n d e s B i o s c i e n c e. N o t f o r d i s t r i b u t i o n .
Surgery, Apr 1, 2011
Two important changes in the past decade have altered the landscape of graduate medical education... more Two important changes in the past decade have altered the landscape of graduate medical education (GME) in the U.S. The national restrictions on trainee duty hours mandated by the Accreditation Council for Graduate Medical Education (ACGME) were the most visible and generated much controversy. Equally important is the ACGME Outcome Project, which mandates competency-based training. Both of these changes have unique implications for surgery trainees, who traditionally spent long hours caring for patients in the hospital, and who must be assessed in 2 broad domains: their medical care of pre-and postoperative patients, and their technical skill with procedures in and out of the operating room. This article summarizes 3 key challenges that lie ahead for surgical educators. First, the changes in duty hours in the past 7 years are summarized, and the conversation about added restrictions planned for July 2011 is reviewed. Next, the current state of the assessment of competency among surgical trainees is reviewed, with an outline of the challenges that need to be overcome to achieve widespread, competency-based training in surgery. Finally, the article summarizes the problems caused by increased reliance on handoffs among trainees as they compensate for decreased time in the hospital, and suggests changes that need to be made to improve safety and efficiency, including how to use handoffs as part of our educational evaluation of residents.
Site-Specific Differences in pp60c-src Activity in Human Colorectal Metastases
Journal of Surgical Research, Apr 1, 1993
The c-src proto-oncogene has been implicated in the progression of primary human colorectal carci... more The c-src proto-oncogene has been implicated in the progression of primary human colorectal carcinoma to hepatic metastasis. To determine if increased pp60c-src tyrosine kinase activity is a colon-specific phenomenon present in colorectal metastases to all sites, the pp60c-src-specific kinase activity of noncolon tumor metastases to the liver was compared to that of colorectal liver metastases. Activity of extrahepatic colon carcinoma metastases was compared to that of colorectal liver metastases as well as that of normal colonic mucosa. The specific activity of pp60c-src in multiple synchronous metastases from colon carcinoma was also examined. Tyrosine kinase activity was determined by immune complex kinase assay; protein levels were determined by immunoblotting. Specific activity was calculated for each group by dividing the total activity by protein level. Colon carcinoma metastases to the liver had significantly (P &lt; 0.04) increased pp60c-src activity with an average 2.2-fold increase over normal mucosa. In contrast, noncolon tumor metastases to the liver showed minimal pp60c-src kinase activity. Extrahepatic colorectal metastases demonstrated significantly increased (P &lt; 0.005) pp60c-src activity with an average 12.7-fold increase over normal mucosa. When compared to colon liver metastases, extrahepatic colorectal tumor metastases show a significant difference in activity (P &lt; 0.05) with an average 5.7-fold increase. Examination of multiple synchronous colon carcinoma metastases confirmed these results. In summary, we conclude that (1) the activation of pp60c-src between primary tumors and metastases is specific to colon metastases, and (2) although pp60c-src activity is significantly increased in colorectal metastases, site-specific differences in the magnitude of activity are evident.
Journal of regional medical campuses, Sep 4, 2019
This issue of the JRMC highlights the important relationship that we share with the Association o... more This issue of the JRMC highlights the important relationship that we share with the Association of American Medical Colleges, Group on Regional Medical Campuses. We are excited to provide, for the first time, extended abstracts of presentations given at the 2019 Group on Regional Medical Campuses Spring Meeting held April 15-17, 2019 in Spokane, WA. Presenters were invited to submit their peer-reviewed abstracts to the JRMC, updated with questions that were considered by the audience and including important take home points. The GRMC Spring Meeting is the premier venue for sharing the work that originates on regional medical campuses in North America and networking with colleagues that work on our campuses. The JRMC is honored to be able to capture a snapshot of the content of importance to our readers. The JRMC Editorial Board would like to thank our partners at the AAMC in Educational Affairs who support our GRMC and who have been instrumental in helping us foster a close working relationship with our regional campus stakeholders-Katherine McOwen, Stephen McKenzie, Ethan Kendrick and Sarah Brown. Their support and encouragement have helped the JRMC expand it readership and to increase its submissions. Enjoy this issue and please let us know your thoughts of what we can do to improve it!
Journal of Surgical Education, 2008
Purpose: Early in their residencies, interns face highly challenging and complex communication si... more Purpose: Early in their residencies, interns face highly challenging and complex communication situations in which they must interact effectively with patients, families, hospital staff, and other physicians, such as at the end of a patient's life. We provide a multidisciplinary and efficient format for interns to improve end-of-life (EOL) communication skills. Methods: Since 2003, a 2.5-hour workshop has been held in September for interns enrolled in programs serviced by the Dayton Area Graduate Medical Education Consortium. The curriculum focuses on 2 key areas: delivering bad news and establishing a "do not resuscitate" order. A multidisciplinary faculty, which is led by a surgical oncologist, facilitates the workshop. Video demonstrations, role play, real-life case discussions, and didactic information are used. A self-assessment is administered before and after the workshop to determine comfort level with various EOL skills. Program directors receive documentation of trainee participation for inclusion in competency portfolios. Results: Two-hundred fifty-nine interns from 17 programs (14 specialties) have participated in the workshop over the past 5 years, which includes 74 general surgery residents. Twelve faculty members with expertise in surgical oncology, trauma, critical care, nephrology, family practice, general internal medicine, palliative care, and adult/ pediatric palliative care nursing have participated. In each of the 13 areas of self-assessment, post-workshop improvement was noted (Table). The largest improvements over the 5-year period were in documenting the outcome of a conference, using "I" statements to make recommendations, and establishing a follow-up plan after delivering bad news. Conclusions: Communication and interpersonal skills can be enhanced by providing a concentrated learning experience in a multidisciplinary format. Inclusion of professionals from different disciplines in the learning and teaching process provides real-life experience with the systems-based practice competency. Although EOL communication skills are often taught in medical school, interns are receptive to learning more about the practical and advanced skills necessary to provide patient care in highly charged situations.
Journal of Surgical Education, 2008
Background: Evidence Based Reviews in Surgery (EBRS) was developed to teach the critical appraisa... more Background: Evidence Based Reviews in Surgery (EBRS) was developed to teach the critical appraisal skills needed by practicing surgeons and residents to interpret and evaluate the surgical literature. A previous trial of practicing general surgeons demonstrated that participation in the online discussion and methodological critiques improved critical appraisal skills compared with receiving a journal article without this support. The American College of Surgeons supports EBRS, which is a benefit of membership for both practicing surgeons and residents. Recently, the American Society of Colorectal Surgeons has incorporated colorectal-specific packages for their members and trainees. Purpose: To introduce program directors to EBRS using demonstration and discussion. Methods: The components of EBRS include a peer-reviewed journal article, a methodological critique of the article, 2 critiques written by clinicians with expertise in the clinical subject area, and a listserv discussion. Eight packages are designed around 8 peer-reviewed journal articles per year. Presenters will demonstrate how to access all EBRS components. Examples of listserv discussion threads will be presented to demonstrate how this discussion improves analytic skills. Features important to Program Directors will be demonstrated, including how to track whether residents have downloaded articles and reviews. Program Directors with experience incorporating EBRS into their programs will facilitate discussion. Conclusions: After participation in this workshop, program directors can navigate the EBRS website, understand how EBRS can be incorporated into their program, and understand how to track resident progress in using EBRS materials. SAGES educational offerings to complement residency training in GI and minimally invasive surgery.
Gastroenterology, Apr 1, 2003
The Charlson-Age Comorbidity Index (CACI) is a validated tool used to predict patient outcome bas... more The Charlson-Age Comorbidity Index (CACI) is a validated tool used to predict patient outcome based on comorbid medical conditions. We wanted to determine if the CACI would predict morbidity and mortality outcomes in patients undergoing surgery for colorectal carcinoma. Records of 279 consecutive colorectal cancer patients who underwent laparotomy by a single surgical group between 1997 and 2001 were reviewed in a retrospective fashion for patient demographics, stage at diagnosis, operation, surgeon, perioperative complications, tumor characteristics, comorbid diseases, performance status, length of stay (LOS), disposition, and mortality. Using the preoperative history and physical, all patients were assigned a score for the CACI. Perioperative morbidity and mortality were recorded and graded to account for severity. The University Statistical Consulting Center and SPSS software were used to analyze the results. The patients were primarily white (97.1%) with a male-to-female ratio of 1:1.2 and a median age of 72 years. AJCC stage at presentation was stage 0 (3.2%), stage I (28.3%), stage II (24.4%), stage III (24.4%), or stage IV (19.7%). Median LOS was 7.0 days. Perioperative mortality was 17 of 279 (6.1%), and overall mortality was 32.6% at a median follow-up of 18.5 months. Higher CACI scores and AJCC stage at presentation correlated with longer LOS and overall mortality. Only the CACI correlated with perioperative mortality and disposition. No correlation was observed with location of tumor, type of surgery, or surgeon. Patients with higher cumulative number of weighted comorbid conditions as indicated by the CACI are at higher risk for perioperative and overall mortality. This simple scoring system is also a significant predictor of disposition (home versus extended care facility) and LOS. The CACI can be a useful preoperative tool to assess and counsel patients undergoing surgery for colorectal carcinoma.
Journal of the American College of Surgeons, 2018
Journal of Surgical Education, Mar 1, 2008
Surgery, Jul 1, 1997
Backgnmnd. Patients in th.e accelerated or blastic phases of chronic ,myelogenou.s leukemia (CAL)... more Backgnmnd. Patients in th.e accelerated or blastic phases of chronic ,myelogenou.s leukemia (CAL) ofen h.a.ve pain@ splenomegaly and secorzdary th:romboqtopenia. 1% tested the hypothesis that splenectomy can be performed with ,minimal comp1ication.s in advanced CML, thereby alleviating pa.in, reversing th:romboqjtopenia, a.xd minimizing transfusion requi,rements. Methods. T/lie reviewed the records of 53 patients in. th.e accelerated or blastic phases of CML who underwent spkn.ectomy between 1970 and 1995 at the CT. ?: M. D. Anderson Carxer Center: Re$ults. Twenty-eight patients were in accelerated phase and 25 in. blastic phase a.t the time of splenectomy. The most common indications fol-splenectomy were sy,mptoma.tic splenomegab (median splenic weight, 1000 gm; range, 120 to 6700 gm) or thrombocytopenia (platelet count less than 100,000/~1) or both. There was 1 death within 30 days of splenectomy. The preoperative platelet cou.nt increa.sed 3.72fold k 0.53-fold (meax f SE&L) by postopmative day 7 (p < 0.001; paired t test). Patients with transfu.sion-dependent thrombocytoperzia had signi$cantly fewer platelet and red blood cell transf&sion.s in the 6 months afer splen.ectomy than in. the 6 'months before splenectom! (p = 0.016; sign. test).
Journal of Surgical Education, Jul 1, 2021
Diversifying the medical work force is critical to reducing health care disparity and improving p... more Diversifying the medical work force is critical to reducing health care disparity and improving patient outcomes. This manuscript offers a comprehensive review of best practices to improve both the recruitment and the retention of underrepresented minorities in training programs and beyond.
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Papers by Paula Termuhlen