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C T Meyer

Publications and source records attributed to C T Meyer.

18 recordsLinked to original sources
PubMed1995

Hold that x-ray: aspirate pH and auscultation prove enteral tube placement.

We report here a prospective study evaluating an alternative to the roentgenographic confirmation of "fine-bore" nasoenteral feeding tubes. Of 78 nasoenteral intubations in 46 patients using a Dobbhoff (Biosearch Medical Products) weighted enteral feeding tube, gastric aspirates were evaluated in 28. Auscultation was performed in all 78. Data was collected at initial placement prior to x-ray confirmation. Observers used color-coded pH paper to analyze gastric aspirate (pH < or = 4) and/or auscultation of the epigastrium to determine feeding tube position prior to x-rays. Auscultation alone was ineffective as a confirmatory test with only 6.3% specificity (p = 0.31). Aspiration to ascertain tube position was very accurate when pH < or = 4.0 (p = 0.0005) and when it was performed. A pH value of > 4 was not very helpful in predicting malposition (37%) especially when pH altering medications were used. Aspiration of contents was successful in 85% of patients. We conclude that when the pH of the nasogastric tube aspirate is < 4.0, x-ray films are not needed to prove the accuracy of tube placement. In other situations, a film is indicated since auscultation is inaccurate.

Adult↗
PubMed1995

Making sense of federal GME reforms: the impact on osteopathic medicine.

Physician workforce issues, particularly the generalist/specialist mix, surfaced as a major component of the healthcare reform debate in the last Congress. Both of the major bills before the Congress at the end of the session would have legislated reforms in graduate medical education designed to control the cost, mix, and supply of physician manpower. This article examines the graduate medical education reform measures proposed in the Gephardt (House) and Mitchell (Senate) bills and identifies elements of agreement. Discussion focuses on the potential for reforms that could be enacted in the new Congress, with a look at the implications for the osteopathic medical profession. A second article, to appear in next month's issue, will focus on recommendations for secondary reforms to prepare osteopathic medical institutions for the changing graduate medical education environment. Such a changing environment requires comprehensive reevaluation in all of the institutions of osteopathic medicine--the colleges, the hospitals, and the American Osteopathic Association.

Education, Medical, Graduate↗
PubMed1995

Making sense of federal GME reforms: the need for secondary reforms.

Physician workforce issues in the healthcare reform debate have led to considerable agreement on the need to reform graduate medical education (GME) in order to control the cost, mix and supply of physician manpower. The osteopathic medical profession's infrastructure is ill-prepared to respond to many of the changes that policymakers are suggesting. In last month's issue, the author reviewed the Gephardt and Mitchell bills, which emerged during the last Congress, identified the reforms recommended for GME, and examined the elements of agreement between the bills. The position of osteopathic medicine vis-à-vis healthcare reform was explored and distinctions between the two bills were drawn. In this article, the author recommends comprehensive secondary reforms in the osteopathic medical profession's three institutions--its colleges, its hospitals, and its political organization, the American Osteopathic Association.

Education, Medical, Graduate↗
PubMed1994

The osteopathic medicine game: new strategies for winning.

The recruitment and retention of osteopathic medical students by osteopathic medical institutions is arguably the most important priority facing the profession today. Residencies accredited by the Accreditation Council on Graduate Medical Education are now the major competitors for osteopathic medical students; osteopathic residency graduates are readily accepted at most hospitals; and osteopathic medical faculty are regularly appointed to university and government positions. As a result, many osteopathic medical institutions are having difficulty in filling their training programs and recruiting faculty and medical staff physicians. These recruitment problems can be resolved by the development of graduate medical education (GME) programs that are competitive with their allopathic GME counterparts, but hospitals and colleges must do so by developing a new approach to osteopathic GME. Osteopathic GME must sell academic quality by developing a university-like environment in the hospitals conducting training programs. Osteopathic training hospitals should consider requiring their directors of medical education to develop strategic plans for GME which result in the development of competitive programs.

Career Choice↗
PubMed1993

Osteopathic medicine: a call for reform.

During the past 40 years, the osteopathic medical profession has undergone a transformation from "osteopathy" to "osteopathic medicine." The former was characterized by manipulative treatment; the latter, by full-service healthcare. During this transformation, the profession has won acceptance from the government, the military, and MDs. These changes in status have resulted in new problems for the profession because DO graduates are increasingly turning toward allopathic programs for residency training. Thus, osteopathic medicine's primary care orientation is being replaced by an emphasis on specialty training. The authors propose that osteopathic medicine return to its original mission of primary care, abandon or restrict specialty training to those who have completed primary care residencies, and rethink its separate-but-equal posture. They also propose that osteopathic medicine establish lines of communication with allopathic medicine, the American Medical Association, and the government to facilitate the development of a rational national policy for primary care that considers the potential osteopathic medicine has to offer in meeting the nation's primary care needs.

Education, Medical, Graduate↗
PubMed1992

The crisis in osteopathic medicine.

During the last 30 years the osteopathic profession has undergone a remarkable transformation from osteopathy, characterized by manipulative therapy, to osteopathic medicine, characterized by full-service health care, and in the process it has won acceptance from the government, the military, and physicians. These changes in status have resulted in new problems for the profession, because D.O. graduates are turning increasingly toward M.D. programs for residency training, and osteopathic medicine's primary care orientation is being replaced by an emphasis on specialty training. The authors advocate that osteopathic medicine return to its original mission of primary care, abandon specialty training or restrict it to those who have completed primary care residencies, abolish its separate-but-equal posture, and establish lines of communication with allopathic medicine and the American Medical Association to facilitate the development of a rational national policy for primary care that considers the potential osteopathy has to offer in meeting the nation's primary care needs.

Education, Medical, Graduate↗
PubMed1990

The Century Club: a model for staff-supported medical education.

Osteopathic teaching hospitals are frequently criticized by house staff officers for not being sufficiently didactic or academically oriented. A model for providing academic training for students, interns, and residents as well as continuing medical education for attending staff physicians is described. This model may be administered by a department of medical education at community hospitals. Tax-deductible financial contributions from medical staff physicians and grants from pharmaceutical companies will be adequate to support this model. Benefits include enhancement of teaching rounds, increased medical staff support, improved compliance with CME requirements, and development of a useful recruitment tool.

Education, Medical↗
PubMed1984

Flexible sigmoidoscopy: diagnostic yield in 1015 patients.

The purposes of our study were to 1) identify the number of neoplastic lesions (adenomatous polyps and cancer) diagnosable by flexible sigmoidoscopy (FS) in patients with symptoms of colorectal disease and 2) determine the age distribution of patients in whom neoplastic lesions are detected by FS. A total of 1015 patients, ages 20-89 years, underwent FS because of the following indications: rectal bleeding, occult blood loss, anemia, change in bowel habit, weight loss, and abdominal pain. FS examined a mean distance of 49 +/- 2 cm (SEM) in an average time of 11.5 min. A bowel preparation of 2 Fleet enemas was adequate in 95% of patients and the examination was well tolerated by all age groups. There were no complications encountered. Eight-five neoplastic lesions were identified in 78 patients. Fifty-four percent of all adenomatous polyps and 61% of the cancers were detected beyond 20 cm. Neoplastic lesions were identified in all adult decades studied, ranging from 3.2% of patients aged 20-40 years, 8.0% for patients between 40 and 60, and 10.1% from 60 to 80; with a peak yield of 11.2% in the 7th decade. Cancer was diagnosed only in patients more than 40 years; 3.3% of patients over 60 had carcinoma compared to 0.8% in patients less than 60. These data provide evidence for the value of FS as a safe initial diagnostic procedure to detect neoplastic lesions in symptomatic patients of all adult age groups.

Adult↗
PubMed1982

Interpretation of the Bernstein test: a reappraisal of criteria.

We evaluated the esophageal acid infusion test (Bernstein test) in respect to the following questions: Does chest pain predictably disappear after cessation of acid infusion, and what is the relation between esophageal intraluminal pH and the degree of chest pain relief? Forty patients with subjective and objective evidence of gastroesophageal acid reflux, in whom esophageal acid infusion had reproduced substernal burning in a mean time of 3.1 minutes +/- 0.8 SE, graded pain relief after stopping acid infusion when saline was being infused. Complete pain relief occurred in 47.5% of patients over a 20-minute period. In six patients, esophageal pH was monitored for 30 minutes after administration of saline, antacid, placebo-antacid, and no treatment for a positive acid infusion test. Esophageal pH returned to normal (greater than 4.0) at the same rate (from 5.0 to 8.3 minutes) among patients in the four treatment groups, whereas chest pain continued and esophageal pH did not correlate with pain relief. The grading of pain relief was similar among the treatment groups, except at the 5-minute period when antacids resulted in significantly better relief than no treatment.

Adult↗
PubMed1981

Hydrogen peroxide colitis: a report of three patients.

We have seen three patients with acute ulcerative colitis after hydrogen peroxide enemas. The colitis is probably the result of the explosive entrance of gas into the loose connective tissues of the mucosa and submucosa of the rectum and sigmoid. Fortunately, it is transitory in nature, but it should be distinguished from ulcerative, ischemic, or pseudomembranous colitis.

Adult↗
PubMed1981

Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature.

Twenty-two patients with colonic arterio-venous malformations (AVM) are reported and 218 other cases in the English literature are reviewed. Of our patients, 16 (73%) underwent right hemicolectomy because of repeated episodes of rectal bleeding or iron-deficiency anemia. Ten (63%) of these patients have remained in good health with no further evidence of intestinal bleeding after surgery. In six (37%) recurrent episodes of rectal bleeding or iron deficiency anemia have gone unexplained despite thorough work-up including repeat arteriography. Our experience and that in the literature suggests: 1. Most AVM's (78%) occur in the cecum or right colon, the jejunum being the next most common site. 2. Patients with AVM's tend to be elderly with a strong history of cardiovascular disease. A potential association between aortic stenosis, intestinal bleeding, and AVM's is suggested. However, prospective studies are needed to confirm this relationship. 3. In younger patients AVM's tend to occur at atypical sites such as the small bowel. 4. Surgical removal of an AVM cannot be expected to be uniformly curative. The causes of recurrent bleeding after surgery include: incomplete resection of the initial AVM, occult AVM's missed on arteriography and left behind at surgery, and the appearance of new AVM's postoperatively. The cause of bleeding in many patients with recurrence however, remains undiagnosed despite repeat angiography.

Adolescent↗
PubMedDate not supplied

Clinical experience with flexible sigmoidoscopy in asymptomatic and symptomatic patients.

The purpose of this study was to evaluate the diagnostic yield of flexible sigmoidoscopy when performed as a routine procedure in asymptomatic patients over the age of 40 being referred for a complete physical examination. The preliminary results of this ongoing program are presented together with the diagnostic yield in 408 patients with symptoms and signs suggestive of colorectal disease who were of similar age (56.6 vs. 56.5 years) and sex distribution (79 percent male) to the asymptomatic population, and who underwent flexible sigmoidoscopy as an indicated part of their evaluation. In the 122 asymptomatic patients, the mean distance examined by the procedure was 50.8 cm with the instrument being advanced beyond the optimal rigid sigmoidoscopy distance of 20 cm in 100 percent of patients. Adenomatous and hyperplastic polyps were identified in 16 patients, 13.1 percent, in the asymptomatic group, a similar percentage to the symptomatic population, 15.4 percent. Adenomatous polyps were diagnosed in 7.4 percent of the asymptomatic subjects and 9.1 percent of the symptomatic group. Colonic cancer was diagnosed in 0.8 percent of asymptomatic patients vs. 3.2 percent of the symptomatic group (p < 0.05). Seventy-seven percent of the neoplastic polyps detected in the asymptomatic patients and 60 percent in the symptomatic group were beyond 20 cm from the anus. Diverticulosis was diagnosed in a similar percentage of patients, 13.1 percent in the asymptomatic and 10.0 percent in the symptomatic group. No complications were encountered and the procedure was well tolerated without analgesia. It is concluded that: (1) in an asymptomatic population over the age of 40, flexible sigmoidoscopy, as a routine examination, results in a diagnostic yield not possible with rigid proctosigmoidoscopy and which approaches that observed in a symptomatic population of similar age; (2) for the internist trained in this procedure, flexible sigmoidoscopy has a future role in the detection of colorectal lesions and as an interval screening examination for premalignant lesions and colorectal cancer in asymptomatic and symptomatic patients.

Adenoma↗