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M B Clearfield

Publications and source records attributed to M B Clearfield.

8 recordsLinked to original sources
PubMed2000

The Comprehensive Osteopathic Medical Licensing Examination, COMLEX-USA: a new paradigm in testing and evaluation.

Medical licensure in the United States demands a dynamic and current means to evaluate the competency of physicians seeking to practice medicine. A systematic measuring tool is required--one that is based on actual patient encounters and how physicians should apply their knowledge and skills to the clinical setting according to their level of training and professional development. Osteopathic physicians have a distinctive approach to healthcare, applying the biopsychosocial model with emphasis on the neuromusculoskeletal system. A component of this distinctive approach is a high level of knowledge and skill in the application of osteopathic manipulative treatment. Developed by the National Board of Osteopathic Medical Examiners, COMPLEX-USA is the new sequential three-level examination process for osteopathic medical licensure in the United States. The examination process is interdisciplinary and highly clinical, with even basic science components tested within a clinical context. Examination content is based on wide expert consensus and data consistent with osteopathic medical education, training, and practice. Its design is a novel multidimensional structure that emphasizes clinical problem-solving skills and osteopathic principles and practice within the context of life cycle, gender, ethnicity, and points of service. Design schemata and blueprints are included along with descriptions of strategic research and development. COMPLEX-USA represents the most appropriate pathway for initial licensure for a distinctive and unique professional: the osteopathic physician in the United States.

Educational Measurement↗
PubMed1998

Decrease in high density lipoprotein cholesterol (HDL-C) levels following gemfibrozil therapy.

This report represents the continuation of our studies on the effects of gemfibrozil therapy on high density lipoprotein cholesterol levels. Previously, we reported that despite an impressive mean increase in high density lipoprotein cholesterol (20%), the response to 12 weeks of gemfibrozil therapy was highly variable. Accordingly, out of the 27 subjects studied, five actually had lower high density lipoprotein cholesterol at the conclusion of therapy compared to baseline values. The changes observed in plasma lipids, combined with correlational relationships suggest that the conversion of triglyceride rich lipoprotein components into high density lipoprotein may be impaired in those subjects that respond poorly or negatively to gemfibrozil therapy.

Adult↗
PubMed1994

Plasma lipids and cholesterol esterification in Alzheimer's disease.

Eight patients and eight age matched controls were recruited to study parameters related to plasma lipoprotein metabolism in Alzheimer's disease based on previous studies in Down's syndrome (A.G. Lacko et al., Clin. Chim. Acta, 132 (1983) 133). The fractional rate of cholesterol esterification (% cholesterol esterified per hour) was 16% lower in the patient group compared with controls. Correlational analyses of lecithin/cholesterol acyltransferase (LCAT) activity and plasma lipids revealed additional differences between the Alzheimer's patients and control subjects. These data are strikingly similar to those obtained earlier with Down's syndrome patients. These data, combined with analyses of cholesteryl ester transfer protein (CETP) levels, suggest that reverse cholesterol transport in general and CETP activity in particular may be altered in Alzheimer's disease.

Aged↗
PubMed1992

The efficacy of gemfibrozil therapy for raising high density lipoprotein levels.

Thirty subjects, 5 normotriglyceridemic (NTG) with low HDL cholesterol (HDL-C < 35 mg/dl) and 25 hypertriglyceridemic (HTG) with low and high HDL-C (HDL-C > 35 mg/dl) were selected fo this study. They were treated with gemfibrozil (600 mg BID) for 12 weeks. In both groups, gemfibrozil significantly reduced serum TG levels (p < 0.005), yet HDL-C increased significantly only in HTG patients (p < 0.005). The changes in HDL-C levels were highly variable (-40 to 50%) and appeared to be dependent on the levels of serum TG achieved during treatment. Based on post-treatment serum TG, the HTG patients were divided into 2 groups. Group 1 with serum TG of < 100 mg/dL and Group 2 with serum TG levels > 100 mg/dl. Significant post treatment increases in HDL-C were seen only in Group 1 (p < 0.005). The two groups had similar pretreatment serum TG and HDL-C levels but the LDL-C was significantly higher in Group 1 (p < 0.025). Pretreatment serum LDL-C also correlated positively with the increases in HDL-C during treatment (r = 0.51, p < 0.01, n = 25). Consequently, the patients were divided into three groups based on their initial serum LDL-C levels (Group 1: LDL-C < 130 mg/dl. Group 2: LDL-C, 130-159 mg/dl and Group 3: LDL-C > 160 mg/dl). The HDL-C levels increased significantly upon treatment only in Group 3. Pretreatment levels of serum TG and HDL-C were not significantly different among the three groups. Initial body weight (r = -0.43 p < 0.025, n = 30) and percent change in body weight during treatment (r = -0.47, p < 0.025, n = 30) correlated negatively with the percent reduction in serum TG. The change in body weight also showed significant negative correlation with the changes in HDL cholesterol (r = -0.48, p < 0.25, n = 30). We conclude that gemfibrozil is most effective in reducing serum triglycerides, LDL-C and increasing serum HDL-cholesterol in HTG patients who also have comparatively high initial LDL cholesterol levels (Fredrickson's type IIb phenotype). For effective improvement of HDL-cholesterol in most HTG patients, serum TG levels need to be lowered below 100 mg/dl. Furthermore, the benefit of gemfibrozil therapy may be significantly enhanced by weight loss during treatment.

Adult↗
PubMedDate not supplied

Evaluation of gemfibrozil therapy: predictive response from lipoprotein subfraction analysis.

Subjects with high-density lipoprotein cholesterol (HDL-C) values of less than 47 mg/dL (mean 35.6 +/- 5.5 mg/dL) were selected for this study to examine relationships between plasma lipids, lipoprotein components, and the outcome of gemfibrozil therapy. Changes in plasma lipoprotein subfractions were determined to better understand the previously observed variability of the responses in both HDL-C and triglycerides to gemfibrozil. Based on the data collected, an attempt was made to identify pretreatment lipid parameters that may be predictive regarding the efficacy of gemfibrozil therapy. Serum samples were analyzed at the outset and after the conclusion of 12 weeks of gemfibrozil therapy. Because the HDL-C response to therapy was highly variable, the data from patients were separated into two groups, responders (>20% increase in HDL-C) and nonresponders (<20% increase in HDL-C). The lipid components of lipoprotein subfractions were evaluated using multiple regression analysis yielding predictive models that show the relationship between specific lipoprotein subfractions and the percentage change in HDL-C and posttreatment triglyceride levels. Group classification was then predicted with 78% accuracy using specific lipoprotein subfractions to estimate an individual's percentage change in HDL-C. The major difference between the responder and nonresponder groups was their respective correlations between triglyceride-lowering and changes in HDL-C. In the responder group, there was a significant correlation between the changes in HDL-C and the lowering of triglycerides (r = 0.61, p = 0.03), whereas the nonresponder group showed no such correlation (r = 0.17, p = 0.52). The predictive model also proved to be highly accurate in forecasting the effectiveness of the triglyceride-lowering action of gemfibrozil in this group of patients.

Adult↗
PubMedDate not supplied

The effect of captopril on the oxidation of plasma lipoproteins.

The antihypertensive drug captopril was found to inhibit the oxidation of low density lipoproteins by copper in a dose dependent manner in vitro. Up to 65% inhibition of oxidation was observed at the concentration of 100 micrograms/ml of captopril. During subsequent studies with patients, captopril protected low density lipoproteins against oxidation slightly better than enalapril, although this difference was not statistically significant. Captopril had no effect on the levels of Lp(a) as compared to the levels established during enalapril treatment.

Aged↗