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Biomedical subjects

K Meyers

Publications and source records attributed to K Meyers.

At least 19 recordsLinked to original sources
PubMed2001

Ulcerative colitis in a renal transplant patient with previous Goodpasture disease.

A renal transplant was performed in a 6-year-old boy who developed end stage renal disease (ESRD) after presenting with antiglomerular basement membrane (anti-GBM) disease. At 10 years of age he developed ulcerative colitis while being immunosuppressed with cyclosporin, prednisone, and azothioprine. He had a pancolectomy, and at 14 years has no symptoms of ulcerative colitis or anti-GBM disease. HLA typing revealed that he was homozygous for HLA DR2. The co-occurrence of anti-GBM disease and ulcerative colitis has not previously been described. Although there is no known common etiology for these two autoimmune diseases, we propose that the patient's homozygosity at HLA DR2 may have predisposed him to both.

Anti-Glomerular Basement Membrane Disease↗
PubMed2000

Advanced practice nursing in pediatric nephrology.

This article provides the nurse practitioner with a concise and accurate reference for the evaluation of children with hematuria, proteinuria, and hypertension. Although the incidence of these disorders in children is lower than in adults, they are not uncommon. The nurse practitioner must be able to accurately assess the results of a urinalysis and measure and interpret blood pressure readings in children. A discussion of when to refer children with signs and symptoms of serious disease; and how to educate patients and families in order to promote children's health is also provided.

Blood Pressure↗
PubMed1999

Mouse tumor model for neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterized by increased incidence of benign and malignant tumors of neural crest origin. Mutations that activate the protooncogene ras, such as loss of Nf1, cooperate with inactivating mutations at the p53 tumor suppressor gene during malignant transformation. One hundred percent of mice harboring null Nf1 and p53 alleles in cis synergize to develop soft tissue sarcomas between 3 and 7 months of age. These sarcomas exhibit loss of heterozygosity at both gene loci and express phenotypic traits characteristic of neural crest derivatives and human NF1 malignancies.

Animals↗
PubMed1999

Critical issues in adolescent substance use assessment.

Despite advances in methodology and instrumentation, the assessment of adolescent drug and alcohol involvement remains a complex clinical and practical process. It requires the careful and skillful implementation of procedures across a wide range of service systems and providers. While the literature identifies and provides information on singular aspects of the assessment of adolescents, few sources furnish an integrated overview of the key issues necessary for appropriate and accountable assessment. Consequently, this paper synthesizes theoretical, research, and clinical issues into a practical framework that can be used by clinical and research staff making assessment decisions. Issues discussed have been informed by the literature and by our collective experience during the 8-year development and testing of the Comprehensive Adolescent Severity Inventory (CASI).

Adolescent↗
PubMed1999

Does clinical case management improve outpatient addiction treatment.

This project evaluated whether clinical case managers (CCMs) could increase access and utilization of social services in the community; and thereby improve outcomes of addiction treatment. No case management (NoCM)--patients received standard, group-based, abstinence-oriented, outpatient drug abuse counseling, approximately twice weekly. Clinical case management (CCM)--patients were treated in the same programs but also were assigned a CCM who provided access to pre-contracted, support services such as drug free housing, medical care, legal referral, and parenting classes from community agencies. CCM patients received more alcohol, medical, employment, and legal services than NoCM patients during treatment. At 6 month follow-up CCM patients showed significantly more improvement in alcohol use, medical status, employment, family relations, and legal status than NoCM patients. We conclude that CCM was an effective method of improving outcomes for substance abuse patients in community treatment programs. Essential elements for successful implementation included extensive training to foster collaboration; and pre-contracting of services to assure availability.

Adult↗
PubMed1999

Inpatient alcohol treatment in a private healthcare setting: which patients benefit and at what cost?

This study investigated whether selected patients have better outcomes with inpatient than outpatient treatment. There were 93 inpatients and 80 outpatients with alcohol dependence who were evaluated at treatment entry to a private healthcare setting. Patients with multiple drinking-related consequences were less likely to return to significant drinking in the first 3 months after treatment ended if they had attended inpatient compared to outpatient treatment. Thus, inpatient appeared to have some advantage over outpatient treatment in the early recovery period for patients with multiple drinking-related consequences. The gap between inpatient and outpatient costs was also reduced when computed as a cost-effectiveness ratio, although treatment costs continued to remain proportionally higher with inpatient than outpatient treatment.

Adult↗
PubMed1999

The relationship of Axis II personality disorders to other known predictors of addiction treatment outcome.

This study evaluated the prevalence of Axis II disorders in substance abuse patients and the relationship between Axis II psychopathology and two other known predictors of adverse addiction treatment outcomes, i.e., Axis I psychiatric comorbidity and illegal drug use, specifically cocaine. 232 patients with cocaine and/or alcohol dependence were admitted to either inpatient or outpatient addiction recovery programs at Carrier Foundation, a nonprofit, private-pay hospital in New Jersey. Axis II disorders were more prevalent in cocaine than alcohol dependence and in patients with Axis I psychiatric comorbidity. When all three predictors were evaluated in one prediction model, the combination of Axis I and II psychopathology was the best predictor of a return to substance use at one year post-treatment, compared to the three factors alone. These findings highlighted the importance of the interrelationship of the relative prognostic value of three known predictors of addiction treatment.

Adolescent↗
PubMed1999

Culture and characterization of equine terminal arch endothelial cells and hoof keratinocytes.

OBJECTIVES: To develop methods to isolate, culture, and characterize equine hoof endothelial cells (EC) and keratinocytes. SAMPLE POPULATION: Cells harvested from the forelimbs of 8 horses. PROCEDURE: EC were obtained via catheters placed in the palmar digital arteries of the disarticulated lower portion of the forelimbs from 4 horses that had been heparinized prior to euthanasia. Phosphate-buffered saline solution was used to remove and discard RBC from blood vessels, and collagenase was used to loosen and flush EC from the vasculature. Hoof keratinocytes were obtained from 4 recently euthanatized horses by use of dispase/trypsin dissociation of the coronary band epidermis. Use of an extracellular matrix gel as a culture flask attachment factor was important to the success of hoof keratinocyte cultures. RESULTS: EC from the palmar digital arteries were successfully cultured and characterized by in vitro morphology, uptake of a fluorescence-labeled acetylated-low density lipoprotein, and lack of expression of von Willebrand factor and smooth muscle actin. Hoof keratinocytes were characterized by morphology in culture and expression of keratin proteins, as determined by immunochemical reaction. Keratinocyte cultures were also positive for vimentin expression. CONCLUSIONS: Culture techniques to isolate and characterize hoof cells should aid investigators in their study of equine hoof pathobiologic features, especially as it relates to laminitis.

Animals↗
PubMed1998

High throughput method for creating and screening recombinant adenoviruses.

Replication defective adenoviruses are being considered as vectors in therapeutic applications of gene therapy, as well as research tools in studying gene function. Important to their successful utilization is the development of techniques to isolate new recombinants quickly, which are not contaminated with wild-type virus. We describe a modification of the traditional technique to create recombinant adenoviruses in which a 5' plasmid containing vector sequence is cotransfected into 293 cells with viral DNA. In our protocol, the viral DNA is derived from the 3' portion of an E1-deleted recombinant that expresses the green fluorescent protein. Visualization of the cotransfection by fluorescent microscopy distinguishes recombinant plaques (nonfluorescent or 'white plaque') from background plaques (green fluorescent or 'green plaque'). Using this approach we have been able to increase substantially the success and throughput for creating new recombinants while minimizing contamination. This has been used to isolate adenoviral vectors deleted in a number of essential genes.

Adenoviridae↗
PubMed1998

Supplemental social services improve outcomes in public addiction treatment.

AIMS: To evaluate the effectiveness and value of social services added to standard addiction rehabilitation. DESIGN: A controlled, quasi-experimental, field study with repeated measures. SETTING: Conducted in two groups of publicly supported outpatient addiction treatment programs. Control programs provided standard, twice-weekly, outpatient group counseling. "Enhanced" programs provided standard counseling but also case managers to coordinate and expedite use of pre-contracted medical screenings, housing assistance, parenting classes and employment services. MEASUREMENTS: The Addiction Severity Index was used to record the nature and severity of patient problems in seven areas at treatment admission and at 6-month follow-up. Services provided during treatment were measured with the Treatment Services Review. Measures were taken on consecutive samples of patients admitted to all programs--before enhancements (wave 1, N = 431)--and at 12 months (wave 2, N = 710); and 26 months following enhancements (wave 3, N = 187). FINDINGS: There were no significant differences in patient characteristics, treatment services or 6-month outcomes of the two sets of programs in wave 1. Wave 2 and especially wave 3 enhanced programs provided significantly more social and medical services than control programs. Patients treated in enhanced programs showed significantly less substance use, fewer physical and mental health problems and better social function at 6-months than Controls. CONCLUSIONS: Adding social services to public sector programs substantially improved the outcomes of addiction treatment. Changes in "real world" systems require time to implement; early evaluations may fail to capture the full impact of those changes.

Adult↗
PubMed1997

"Intensive" outpatient substance abuse treatment: comparisons with "traditional" outpatient treatment.

UNLABELLED: Do "intensive," freestanding outpatient substance abuse treatment programs actually provide more intensive services than "traditional" outpatient programs? Three hundred and thirty-eight patients in 6 "intensive" outpatient (IO) programs (three or more times weekly) were compared with 580 patients from 10 "traditional" outpatient (TO) programs (one or two times weekly) on severity of admission problems, treatment services received and six month outcomes. RESULTS: 1. IO subjects generally had the most severe medical, employment, legal and psychiatric problems at admission. 2. IO patients received more alcohol and drug focused services; but fewer medical and employment focused services than the TO patients. Both groups received very few psychosocial services. 3. There were not significant differences between the IO and TO program samples at follow-up. However, both groups showed significant reductions in substance use, improvements in personal health and social function.

Adult↗
PubMed1997

Goodpasture syndrome involving overlap with Wegener's granulomatosis and anti-glomerular basement membrane disease.

A 68-year-old Caucasian woman presented to the hospital with nodular pulmonary infiltrates and acute renal failure. Wegener's granulomatosis was initially considered to be most likely because of the presence of increased serum levels of c-anti-neutrophil cytoplasmic antibodies (c-ANCA). A consultation through the Internet after a renal biopsy demonstrated crescentic, necrotizing glomerulonephritis and linear deposits of immunoglobulin G (IgG) and complement C3, typical of anti-glomerular basement membrane (GBM) disease. Hemodialysis was instituted; however, the patient suddenly developed a massive cerebral hemorrhage and died before full therapy could take effect. Postmortem analysis of the patient's sera revealed high titers of IgG against the alpha 3 NC1 domain of type IV collagen. Serologic evidence of both p-ANCA and anti-GBM antibodies are becoming more frequently recognized in the setting of rapidly progressive glomerulonephritis. The patient reported here had the unusual combination of c-ANCA antibodies with anti-GBM disease, and this association raises complex questions regarding the pathogenesis of this type of renal injury.

Acute Kidney Injury↗
PubMed1997

[Von Willebrand factor concentrations in blood plasma of Bernese mountain dogs].

Many Bernese Mountain dogs have been found to exhibit an increased hemorrhagic tendency of unknown etiology. Since other bleeding disorders have been excluded by routine tests and Bernese Mountain dogs have been listed to have von Willebrand's disease (vWD), we analyzed the plasma concentration of the von Willebrand Factor (vWF) in 160 Bernese Mountain dogs that were used for breeding in Switzerland in 1992. We also evaluated the suitability of the commercial Asserachrom vWF test kit to quantitate vWF in canine plasma by comparing the plasma vWF determination with validated vWF ELISA test. The vWF plasma concentration in Bernese Mountain dogs ranged from 13% to 162%, with the Asserachrom test kit (normal range 67% to 124%). Similar values were obtained with the research vWF ELISA kit (10% to 166%), and there was a close correlation between the two test methods. In 8 of the 9 Bernese Mountain dogs with initially low vWF concentration (< 60%), the determination was repeated on another sample. Since the values were well within the normal range, a problem with the collection of blood for the first determination is suspected. We conclude that vWD does not appear to be a clinical issue in Bernese Mountain dogs in Switzerland and is, therefore, not likely to be the cause of the observed bleeding tendency. The commercially available Asserachrom vWF test kit seems suitable for the determination of canine vWF plasma concentrations. It is recommended that low vWF values will be confirmed by the determination in second samples.

Animals↗
PubMed1997

An empirical study of the Health Status Questionnaire System for use in patient-computer interaction.

Patient involvement in the health care process is very important to any attempt to improve health care quality and patient satisfaction. Although many computerized medical record systems have been introduced, physicians are the only players in the process of data collection and interpretation. A computerized version of the Health Status Questionnaire has been developed to provide a simple, inexpensive method of direct patient entry into the medical record. The system philosophy emphasizes user-centered design and an empirical study was conducted with one hundred twelve outpatients to evaluate the interface aspects of the system as well as the hardware preference of the patients. Statistical analysis indicate that the patients involved in the study rated the user interface of the Health Status Questionnaire System highly. The study also revealed that a considerable number of the general population still have negative preconceptions about their ability to handle a computer or similar looking machinery. When they were asked to use a desktop computer with a mouse, 26 out of 50 patients refused, while 61 out of 62 agreed to use a hand-held pen computer.

Attitude to Computers↗
PubMed1997

Evaluation of a video-supplement to informed consent: injection drug users and preventive HIV vaccine efficacy trials.

We evaluate the impact of a videotape specially produced to supplement written information about preventive HIV vaccine trials. One hundred eighty-six injection drug users were randomly assigned to an education session in which either: (a) a pamphlet was reviewed before a brief discussion period or (b) the videotape was watched prior to reviewing the pamphlet and participating in the discussion. The relationship among retention of information, trust in government, and willingness to participate in a vaccine trial was tested before the presentation of information, immediately after, and 1 month later. Results indicate that both methods produced significant increases in knowledge immediately after information presentation, but only the video-supplemented group retained the information 1 month later. Subjects receiving the video supplement also showed a significant increase in trust at the first posttest period, but this increase was not maintained 1 month later. Regardless of group assignment or evaluation point, willingness to participate was not associated with knowledge but was associated with trust in government.

AIDS Vaccines↗
PubMed1996

The natural history of outpatient alcohol and drug abuse treatment in a private healthcare setting.

Managed healthcare has had a major impact on the delivery of alcohol and drug abuse treatment services in the private setting, primarily by shifting patient enrollment from inpatient to outpatient treatment programs. The purpose of this study was to investigate the natural history of outpatient alcohol and drug abuse treatment in a private, nonprofit healthcare setting. Patient profiles at pretreatment, their attendance record in a 6-week outpatient program, and their outcome in the year after treatment were evaluated in 120 patients with a DSM-III-R diagnosis of alcohol and/or cocaine dependence. There were 70 outpatients who successfully completed the program, and 50 who did not. Two subtypes of outpatient treatment failures were identified: S5 who prematurely left treatment against medical advice (n = 23), and S8 who attended treatment but continued heavy use of substances (Treatment Resistant, n = 27). A logistic regression revealed that younger age, multiple prior treatments, and employment problems were related to outpatient treatment failure. Outpatient failures did not immediately seek alternative treatment, and most of them continued heavy substance use in the year post-treatment: i.e., 82% vs. 43% successful completers (chi 2 = 13.8, df = 1, p < 0.01). Thus, there were a clinically relevant number of outpatient failures (42%), either because of lack of program attendance or continued substance use throughout treatment. These behaviors were related to continued heavy use of substances in the year after treatment.

Adult↗
PubMed1996

Immunohistochemical staining of fixed tissue using antigen retrieval and a thermal cycler.

The use of monoclonal antibodies to identify antigens in perfused fixed tissue is currently very challenging. Recently, many antigen retrieval methods have been described that require heating the tissue on slides using a microwave oven. Here, we describe a protocol for antigen retrieval that uses a commercially available solution called Citra and a DNA thermal cycler to heat the tissue sections. This method (i) allows for precise control of the temperature and time (unlike the microwave oven), (ii) uses very small quantities of the antigen retrieval solution, (iii) stains either free-floating sections or sections mounted on slides and (iv) achieves uniform staining throughout the tissue. In the paraformaldehyde-perfused fixed rat cerebellum, the monoclonal antibody glial fibrillary acidic protein conveys the clarity of the Bergmann and stellate glia in the strata. Scanning confocal images through the center of the tissue demonstrates the depth of antibody penetration achieved using this method. Finally, using a monoclonal antibody against the simian virus 40 (SV40) T antigen allowed positive, unequivocal identification of a grafted cell line, immortalized using SV40 T protein, thus demonstrating the true value of this method in an experimental paradigm.

Aldehydes↗