Biomedical subjects
Publications and source records attributed to M Clarfield.
Self-help books proliferate today, but the concept of helping oneself in health matters is certainly not a modern phenomenon, Dr. Mark Clarfield notes. He recently studied a self-help booklet from 1936, What to do until the doctor comes, in which he found not only some sound advice but also some harmless suggestions, useless treatments and dangerous remedies.
Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.
Since the discovery of a significant depletion of acetylcholine in discrete areas of the brain of patients affected by Alzheimer's disease, attempts at symptomatic therapy have concentrated on acetylcholine supplementation, an approach that is based upon the efficacy of dopaminergic supplementation therapy for Parkinson's disease. Choline, then lecithin, used orally, failed to improve symptoms but the hypothesis that long-term choline supplementation might stabilize the course of Alzheimer's disease remains to be tested. Nerve growth factor may also offer that possibility. Bethanechol administered intracerebroventricularly did not help when a fixed dose was used but individual titration of more selective muscarinic agonists may prove more effective. In this article we report that tetrahydroaminoacridine (THA), given together with highly concentrated lecithin, appears to bring improvement in cognition and in functional autonomy using the Mini Mental State and the Rapid Disability Rating Scale-2 respectively, without change in behavior as reflected by the Behave-AD. Double-blind cross-over studies are in progress to establish its efficacy. Improvement in study design and means of assessment of cognition, functional autonomy and behavior have been made possible by these drug trials.
We studied the anterior tibial compartment pressures during the application of a JOBST sequential intermittent pneumatic compression device on 5 healthy human volunteers (10 legs). Intracompartmental pressures were measured using a slit catheter. The measurements of interstitial pressures were highest at maximal calf inflation, and pressures were increased for approximately 120 seconds during each cycle. Pressure measurements in the inflated pressure sleeve varied less than 10% with the measured anterior tibial compartment pressures during intermittent pneumatic compression therapy. This intermittent pneumatic compression device may elevate intramuscular pressure significantly above that necessary to render muscle ischemic. However, these periods of pressure elevation are not long enough to produce any significant adverse effects, and the beneficial effects of decreased edema fluid may be safely realized.