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Connolly MA, Trentalange M, Zeiss CJ. Long-Term Clinical Outcomes in Diabetic Rhesus Macaques (Macaca mulatta) Treated with Medroxyprogesterone Acetate for Endometriosis. Comp Med 2016; 66:343-8. [PMID: 27538865 PMCID: PMC4983176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/01/2015] [Accepted: 12/11/2015] [Indexed: 06/06/2023]
Abstract
Depot medroxyprogesterone acetate (DMPA) is a common medical treatment for endometriosis in NHP. Because DMPA reportedly impairs glucoregulatory function in humans and rhesus macaques, as well as predisposes humans to diabetes mellitus (DM), we performed a retrospective study to further investigate its potential long-term clinical effects in animals with and without DM. Using a cohort of 29 rhesus macaques, we explored the hypotheses that DMPA treatment accelerates the onset of DM and that its use in rhesus macaques with endometriosis worsens clinical outcome measures (lifespan, body weight and body condition score). For both body weight and body condition score, a declining and statistically significant trend in mean values was evident as macaques developed either DM, or endometriosis or both. The addition of DMPA did not significantly alter this pattern. The presence of DM, endometriosis, or DMPA treatment statistically but not clinically significantly increased risk of death. Similarly, the presence of the 2 highly correlated variables endometriosis and DMPA treatment statistically but not clinically significantly increased the risk of incident DM. These results indicate that DMPA treatment was associated with worsening trends in lifespan and incident DM, however these trends did not achieve clinical significance in this cohort.
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Affiliation(s)
| | - Mark Trentalange
- Yale Program on Aging, Biostatistics Core, Yale University, New Haven, Connecticut, USA
| | - Caroline J Zeiss
- Section of Comparative Medicine, Yale University, New Haven, Connecticut, USA
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Kane NB, Healy GM, Connolly MA. Learning from H1N1--hospital doctors and pandemic influenza. Ir Med J 2010; 103:156. [PMID: 20669388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Linder JA, Bates DW, Williams DH, Connolly MA, Middleton B. Acute infections in primary care: accuracy of electronic diagnoses and electronic antibiotic prescribing. J Am Med Inform Assoc 2006; 13:61-6. [PMID: 16221947 PMCID: PMC1380198 DOI: 10.1197/jamia.m1780] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 09/21/2005] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To maximize effectiveness, clinical decision-support systems must have access to accurate diagnostic and prescribing information. We measured the accuracy of electronic claims diagnoses and electronic antibiotic prescribing for acute respiratory infections (ARIs) and urinary tract infections (UTIs) in primary care. DESIGN A retrospective, cross-sectional study of randomly selected visits to nine clinics in the Brigham and Women's Practice-Based Research Network between 2000 and 2003 with a principal claims diagnosis of an ARI or UTI (N = 827). MEASUREMENTS We compared electronic billing diagnoses and electronic antibiotic prescribing to the gold standard of blinded chart review. RESULTS Claims-derived, electronic ARI diagnoses had a sensitivity of 98%, specificity of 96%, and positive predictive value of 96%. Claims-derived, electronic UTI diagnoses had a sensitivity of 100%, specificity of 87%, and positive predictive value of 85%. According to the visit note, physicians prescribed antibiotics in 45% of ARI visits and 73% of UTI visits. Electronic antibiotic prescribing had a sensitivity of 43%, specificity of 93%, positive predictive value of 90%, and simple agreement of 64%. The sensitivity of electronic antibiotic prescribing increased over time from 22% in 2000 to 58% in 2003 (p for trend < 0.0001). CONCLUSION Claims-derived, electronic diagnoses for ARIs and UTIs appear accurate. Although closing, a large gap persists between antibiotic prescribing documented in the visit note and the use of electronic antibiotic prescribing. Barriers to electronic antibiotic prescribing in primary care must be addressed to leverage the potential that computerized decision-support systems offer in reducing costs, improving quality, and improving patient safety.
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Affiliation(s)
- Jeffrey A Linder
- Division of General Medicine, Brigham and Women's Hospital, 1620 Tremont Street, BC-3-2X, Boston, MA 02120, USA.
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Tootla R, Kotru G, Connolly MA, Duggal MS, Toumba KJ. Asthma inhalers and subsurface enamel demineralisation: an in situ pilot study. Eur J Paediatr Dent 2005; 6:139-43. [PMID: 16216094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIM The purpose of this pilot study was to identify the subsurface enamel demineralising potential of two possible acidogenic lactose-based powders and their corresponding generic pump inhalers. METHODS Ten healthy non-asthmatic adults participated in a 5- leg randomised crossover study including a 10% sucrose control. A twice-daily 400 microg dose of inhaler was applied in vitro to a demineralised enamel slab on the buccal flange of a mandibular removable appliance before in situ placement for 14 days each. Lesion parameters were determined using transverse microradiography and digitised image analysis. RESULTS Minimal demineralisation occurred with sucrose, both pump and one powder inhaler. The remaining powder was associated with remineralisation (p = 0.29). Overall, mean lesion depth increased (p = 0.12). CONCLUSION Asthma inhalers failed to demonstrate a significant acidogenic/cariogenic effect.
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Affiliation(s)
- R Tootla
- Dept. Paediatric Dentistry, Leeds Dental Institute, England
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Leyden JJ, Berger RS, Dunlap FE, Ellis CN, Connolly MA, Levy SF. Comparison of the efficacy and safety of a combination topical gel formulation of benzoyl peroxide and clindamycin with benzoyl peroxide, clindamycin and vehicle gel in the treatments of acne vulgaris. Am J Clin Dermatol 2002; 2:33-9. [PMID: 11702619 DOI: 10.2165/00128071-200102010-00006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Topical clindamycin and benzoyl peroxide have each demonstrated clinical efficacy in the treatment of acne vulgaris. When used in combination, they promise greater efficacy than either individual agent used alone and the combined use of benzoyl peroxide with topical antibacterial has been shown to decrease the emergence of antibacterial resistant species. OBJECTIVE The objective was to determine the efficacy and safety of a combination benzoyl peroxide plus clindamycin in a gel formulation compared with each of its 2 active constituents in gel vehicle, and gel vehicle given alone in the treatment of acne vulgaris. METHODS In this 10-week, multicenter, double-blind trial, 480 patients with moderate to moderately severe acne were randomized to receive twice-daily treatment with 5% benzoyl peroxide plus 1% clindamycin, 5% benzoyl peroxide, 1% clindamycin, or vehicle. RESULTS Significantly greater reductions in the number of inflammatory and total lesions were demonstrated in patients using combination therapy compared with those using any of its 3 individual components. Likewise, both physicians' and patients' global evaluations showed significantly greater improvements with the combination therapy than with its individual components. The most frequent adverse effect, dry skin, occurred to a similar extent in the combination and benzoyl peroxide treatment groups. CONCLUSION The improved efficacy obtained with the combination therapy was accompanied by a tolerability profile similar to that of benzoyl peroxide alone, making this new combination product an alternative antimicrobial therapy for acne vulgaris.
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Affiliation(s)
- J J Leyden
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Connolly MA. Chest X-rays. Completing the picture. RN 2001; 64:56-62; quiz 64. [PMID: 12032933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- M A Connolly
- Department of Medical-Surgical Nursing, Niehoff School of Nursing, Loyola University, Chicago, USA
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Abstract
Chest radiographs remain one of the oldest, noninvasive methods for identifying chest diseases. This tool is relatively inexpensive, low risk, and important for the advanced practice nurse to use in making an initial differential diagnosis. Timely intervention depends on the advanced practice nurse's ability to recognize the radiographic abnormalities commonly associated with acute pulmonary disease. When linked with the history, presenting signs and symptoms, and a thorough physical assessment, the chest radiograph is key to appropriate diagnosis and management. This article reviews the basic radiographic lung densities, describes a systematic approach to ensure thorough chest radiographic interpretation, and presents characteristic chest radiographs found in the acute care setting. Selected examples of diffuse lung diseases, localized alveolar opacities, pleural effusions, and hyperlucency of the lungs will also be presented.
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Affiliation(s)
- M A Connolly
- Department of Medical-Surgical Nursing, Loyola University Chicago, 15617 Linden Drive, Oak Forest, IL 60452-2613, USA.
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Tschen EH, Katz HI, Jones TM, Monroe EW, Kraus SJ, Connolly MA, Levy SF. A combination benzoyl peroxide and clindamycin topical gel compared with benzoyl peroxide, clindamycin phosphate, and vehicle in the treatment of acne vulgaris. Cutis 2001; 67:165-9. [PMID: 11236229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A topical gel combining 5% benzoyl peroxide and 1% clindamycin as phosphate was evaluated in a 10-week randomized double-blind trial involving 287 patients with moderate to moderately severe acne. The combination agent demonstrated significantly greater reductions in inflammatory lesions than either of its active constituents (5% benzoyl peroxide and 1% clindamycin) or vehicle when used alone. Significantly greater reductions in comedos and improvements, as measured by both physicians' and patients' global evaluations, were obtained with the combination agent than with clindamycin or vehicle. The reduction in comedos and the global improvements were similar between the combination agent and benzoyl peroxide. The combination agent was well tolerated; the incidence of dry skin was similar to that found with benzoyl peroxide, and other adverse events were similar to that with vehicle. The improved efficacy obtained with combination therapy was accompanied by a safety profile similar to that of either constituent used alone.
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Affiliation(s)
- E H Tschen
- Academic Dermatology Associates, Albuquerque, New Mexico, USA
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Abstract
The purpose of this paper is to highlight important considerations in the measurement of health-related quality of life (HR-QOL) in paediatric populations. Considerations specific to the evaluation of HR-QOL in children include children's understanding of the questions being asked, their understanding of their own disease, using parents as proxies, time perception problems and simply the fact that children are continually changing. We provide a review of the currently available literature regarding paediatric HR-QOL assessments to examine the different instruments and approaches taken to assess HR-QOL in paediatrics. Asthma-specific measures are discussed as examples of condition-specific HR-QOL instruments because of the considerable amount of methodological and developmental work that has been conducted in this disease. Our search strategy revealed 15 main generic and 5 main asthma-specific instruments that met our criteria for inclusion. The main points high-lighted for each instrument are the description of domains, respondent (i.e. the child, parent or clinician), age group, number of items, format of instrument (usually self-administered or by interview), original country and language, and the existence of translations. For the various studies in which the different instruments are used, the issues of patient population tested, sample size, reliability and validity are addressed. Although this paper does not attempt to be an exhaustive study of paediatric HR-QOL instruments, we provide an overview of the main generic and asthma-specific instruments, as well as an examination of the different methods used in assessing paediatric HR-QOL. Many challenges exist in the measurement of HR-QOL in paediatric patients. With increased attention to the considerations high-lighted, the field will continue to grow, and the usefulness and application of HR-QOL measures in paediatric patients is likely to improve.
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Affiliation(s)
- M A Connolly
- Institute of Health Economics, Edmonton, Alberta, Canada
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Connolly MA. Clinical snapshot. Postdural puncture headache. Am J Nurs 1999; 99:48-9. [PMID: 10579025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Johnson JA, Connolly MA, Jacobs P, Montgomery M, Brown NE, Zuberbuhler P. Cost of care for individuals with cystic fibrosis: a regression approach to determining the impact of recombinant human DNase. Pharmacotherapy 1999; 19:1159-66. [PMID: 10512065 DOI: 10.1592/phco.19.15.1159.30580] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We estimated direct medical costs of care and important determinants of the costs in patients with cystic fibrosis (CF), including therapy with recombinant human DNase (rhDNase). Costs were estimated with resource use data from the Epidemiologic Study of Cystic Fibrosis. Ordinary least squares regression was used to determine the effect of clinical and demographic variables on individual cost of care. The estimated cost of caring for 303 patients in Alberta was $2,279,801 in 1996. The mean cost of care was $7524 (range $386-92,376)/patient. Regression results indicated that age and forced expiratory volume predicted had a negative association with costs. Being female, receiving rhDNase, and having Pseudomonas aeruginosa or Burkholderia cepacia were all associated with high costs. Our estimates indicated large interindividual variation in cost of care for patients with CF.
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Affiliation(s)
- J A Johnson
- Institute of Health Economics, Faculty of Pharmacy and Pharmaceutical Sciences, the University of Alberta, Edmonton, Canada
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Abstract
Polymerase chain reaction (PCR) using the Mycoplasma fermentans insertion sequence-like element (ISLE) RW primer set amplifies DNA from Mycoplasma orale when more than 1 ng is present in the reaction tube. In this study, amplified products from 11 different clinical isolates and the ATCC prototype of M. orale were sequenced and compared to 206 bp amplicons from eight isolates and the ATCC strain of M. fermentans. The nucleotide sequences of the amplified M. orale products had high sequence homology (88-92%) to those from M. fermentans, but differed at several key positions. The M. orale products contained a DraI restriction enzyme site not found in any of the M. fermentans amplified products. Consistent with this finding, the PCR products from M. orale were digested by DraI while the PCR products from M. fermentans were resistant to DraI digestion. The results suggest that M. orale may carry a similar IS-like element that complicates but does not negate using the ISLE PCR assay designed to detect M. fermentans. It appears possible for the RW primers to amplify M. orale if the mycoplasmas are present at higher concentrations. The amplified products can be differentiated from those from M. fermentans by a rapid DraI restriction endonuclease digestion or by Southern blot analysis using the RW006 internal probe under highly stringent conditions.
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Affiliation(s)
- S E Ditty
- Department of Infectious and Parasitic Diseases Pathology, American Registry of Pathology, Washington, DC 20306, USA
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Abstract
Lung volume reduction is a new surgical procedure for patients with severe emphysema. The hyperinflated portion of the lung or lungs is removed so the patient's chest wall and diaphragm can return to normal positions, easing breathing. This article describes the patient criteria, surgical procedure, and nursing problems and interventions related to the care of the lung volume reduction patient.
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Hirschfeld RM, Russell JM, Delgado PL, Fawcett J, Friedman RA, Harrison WM, Koran LM, Miller IW, Thase ME, Howland RH, Connolly MA, Miceli RJ. Predictors of response to acute treatment of chronic and double depression with sertraline or imipramine. J Clin Psychiatry 1998; 59:669-75. [PMID: 9921701 DOI: 10.4088/jcp.v59n1205] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The literature on predictors of response to treatment of nonchronic major depression has identified shorter duration of illness, acute onset, and less severity of illness as positive predictors. Unfortunately, there are almost no data on predictors of response to treatment for chronic depression. This study examined predictors of response to pharmacotherapy (sertraline or imipramine) in the treatment of outpatients who had DSM-III-R-defined chronic major or double depression. METHOD The acute phase of the Chronic Major Depression and Double Depression Study is a double-blind, randomized, parallel-group 12-week comparison of sertraline and imipramine. Analyses are based on 623 patients who comprised the intent-to-treat sample, of whom 299 were nonresponders and 324 were responders, defined by a priori criteria as either remission or satisfactory therapeutic response. A stepwise logistic multiple regression analysis was performed on candidate clinical, psychosocial, and demographic variables previously identified as statistically significant in an attempt to develop a predictive model of positive antidepressant response. RESULTS The sociodemographic variables that were predictive of positive response included living with spouse or partner or being at least a high school graduate. With regard to symptomatology and clinical history, responders had significantly lower baseline depression severity scores. In general, comorbid anxiety, substance abuse, and personality disorders did not influence rates of response. However, the presence of depressive personality traits was associated with a higher nonresponse rate. Among psychosocial variables, longer duration of personal relationships as well as higher baseline quality of life were associated with positive response. A stepwise logistic multiple regression identified 5 variables-living with spouse or partner, higher educational level, passive-aggressive personality, lower introverted-tense personality traits, and higher quality of life--that significantly and independently contributed to the predictive model. This model correctly classified 67% of patients. CONCLUSION A higher baseline quality of life, living with spouse or partner, and having more education were the strongest predictors of response to acute pharmacotherapy among chronically depressed patients. Clinical variables and comorbidity were not identified as independent predictors, although personality traits did appear to influence treatment response. Overall, the predictive value of these baseline measures was modest, and therefore of limited clinical utility.
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Affiliation(s)
- R M Hirschfeld
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston 77555-0429, USA
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Connolly MA. How healthy are critical care nurses? Crit Care Nurse 1998. [DOI: 10.4037/ccn1998.18.5.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Connolly MA. How healthy are critical care nurses? Crit Care Nurse 1998; 18:104. [PMID: 9934055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- M A Connolly
- Niehoff School of Nursing, Loyola University, Chicago, Maywood, Ill., USA
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Abstract
BACKGROUND: Few studies have explored the health practices of critical care nurses. Critical care nurses routinely teach patients about using healthy practices such as low-fat diets, exercise, and routine screening examinations. However, it may be even more important that the nurses themselves have a healthy lifestyle, thus serving as role models for patients. Nurses are selling a product, and that product is health. The best salespersons are those who are genuinely committed to their product and model its benefits. Therefore, critical care nurses' healthful practices can have a profound effect on their patients. OBJECTIVES: The purpose of this descriptive exploratory study was to examine critical care nurses' responses to three questions about health practices in their daily lives: (1) What are critical care nurses doing currently to stay healthy? (2) Do they anticipate making any changes in their lifestyle in the future? (3) Would they recommend their lifestyle to their patients? METHODS: One hundred twenty-seven critical care nurses attending a midwestern critical care conference completed a two-part questionnaire designed to produce a health profile. In a man-on-the-street approach, 23 nurses participated in an interview via video camera. Descriptive statistics were used to analyze the data retrieved from the questionnaires. Interviews were transcribed verbatim and analyzed for themes with a constant comparative method. RESULTS: More than 70% of the critical care nurses who responded engage in exercise and follow a healthy, low-fat diet. Seventy-one percent said that they anticipate making a change in their lifestyle in the future, and 70% said that they would recommend their lifestyle to their patients. Five themes emerged from the videotaped interviews: (1) Heart-healthy practices predominated the responses. (2) Incorporating a healthy lifestyle was easy for some and a struggle for others. (3) Critical care nurses readily listed barriers to healthy living. (4) The nurses had a positive attitude about their healthy lifestyles and felt optimistic about being role models for their patients. (5) Future plans were either singular in focus or limited to maintenance of current health habits. CONCLUSIONS: The majority of the nurses reported practicing a healthy lifestyle and thought that they were good role models for patients.
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Connolly MA, Gulanick M, Keough V, Holm K. Health practices of critical care nurses: are these nurses good role models for patients? Am J Crit Care 1997; 6:261-6. [PMID: 9215422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Few studies have explored the health practices of critical care nurses. Critical care nurses routinely teach patients about using healthy practices such as low-fat diets, exercise, and routine screening examinations. However, it may be even more important that the nurses themselves have a healthy lifestyle, thus serving as role models for patients. Nurses are selling a product, and that product is health. The best salespersons are those who are genuinely committed to their product and model its benefits. Therefore, critical care nurses' healthful practices can have a profound effect on their patients. OBJECTIVES The purpose of this descriptive exploratory study was to examine critical care nurses' responses to three questions about health practices in their daily lives: (1) What are critical care nurses doing currently to stay healthy? (2) Do they anticipate making any changes in their lifestyle in the future? (3) Would they recommend their lifestyle to their patients? METHODS One hundred twenty-seven critical care nurses attending a midwestern critical care conference completed a two-part questionnaire designed to produce a health profile. In a man-on-the-street approach, 23 nurses participated in an interview via video camera. Descriptive statistics were used to analyze the data retrieved from the questionnaires. Interviews were transcribed verbatim and analyzed for themes with a constant comparative method. RESULTS More than 70% of the critical care nurses who responded engage in exercise and follow a healthy, low-fat diet. Seventy-one percent said that they anticipate making a change in their lifestyle in the future, and 70% said that they would recommend their lifestyle to their patients. Five themes emerged from the videotaped interviews: (1) Heart-healthy practices predominated the responses. (2) Incorporating a healthy lifestyle was easy for some and a struggle for others. (3) Critical care nurses readily listed barriers to healthy living. (4) The nurses had a positive attitude about their healthy lifestyles and felt optimistic about being role models for their patients. (5) Future plans were either singular in focus or limited to maintenance of current health habits. CONCLUSIONS The majority of the nurses reported practicing a healthy lifestyle and thought that they were good role models for patients.
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Affiliation(s)
- M A Connolly
- Niehoff School of Nursing, Loyola University Chicago, III, USA
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Connolly MA, Ritchie S. An audit of in-patients aged 18-65 in acute psychiatric wards who are inappropriately placed three months after admission. Health Bull (Edinb) 1997; 55:156-61. [PMID: 9364103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To identify acute psychiatric patients considered inappropriately placed three months after admission and expedite a more suitable placement by improving liaison with social work. DESIGN A survey established the point prevalence of inappropriately placed patients. Changes in usual practice were implemented with the identification of a named social worker for each ward and the introduction of a 'contact sheet' which updated the progress of these patients monthly. A repeat survey one year later assessed the impact of these changes. SETTING Gartnavel Royal Hospital, Greater Glasgow Community and Mental Health NHS Trust. SUBJECTS Patients aged 18-65 in the acute psychiatric wards who were resident beyond three months. RESULTS Use of the contact sheet and improved liaison with a named social worker did not shorten the length of stay of the inappropriately placed patients. Conversely, their mean value for in-patient weeks on the dates surveyed increased from 41.8 in 1994 to 64.7 in 1995. (p = 0.05, 95% confidence intervals from -1 to 42. The length of stay of patients who were still considered to be appropriately placed beyond three months after admission decreased from a mean of 47.7 to 31.9 weeks. (p > 0.5, 95% confidence intervals from -16 to 16). By 1995 the mean length of stay was significantly greater for inappropriately placed patients (p = 0.008, 95% confidence intervals from 10 to 47). CONCLUSIONS Improved liaison with social work at an operational level was not sufficient to solve the problem of inappropriately placed patients on acute wards. Additional factors such as limited access to rehabilitation placements and patients having complex physical or behavioural problems made placement elsewhere difficult. Such patients with unmet needs place increasing strain on acute psychiatric beds. A reappraisal of current services is required.
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Abstract
The incidence of laryngospasm in the PACU after extubation remains low despite the number of extubations that are performed annually. A study of general anesthesia patients conducted by Olsson and Hallen in 1977 & reported by Holmes et al (Am J Sports Med 19:365-371, 1991) showed the incidence of laryngospasm to be 8.7/1,000 patients. A literature review since 1977 presents a clinical picture of an emergent situation that may be anticipated by nursing staff (Hamlin et al: J Post Anesth Nurs 6:43-49, 1991). Noncardiogenic pulmonary edema (NCPE), also called negative-pressure pulmonary edema (NPPE) (De Franco M: Crit Care Nurse 9:20-22, 1993), and postextubation laryngospasm induced pulmonary edema (LIPE), can be a serious complication of laryngospasm. Its etiology and thus its treatment differs from other forms of noncardiogenic pulmonary edema, such as acute respiratory distress syndrome (ARDS). The PACU nurse must be aware that any patient has the potential for postextubation laryngospasm, and must be prepared to initiate appropriate treatment of noncardiogenic pulmonary edema.
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Steiner JP, Connolly MA, Valentine HL, Hamilton GS, Dawson TM, Hester L, Snyder SH. Neurotrophic actions of nonimmunosuppressive analogues of immunosuppressive drugs FK506, rapamycin and cyclosporin A. Nat Med 1997; 3:421-8. [PMID: 9095176 DOI: 10.1038/nm0497-421] [Citation(s) in RCA: 261] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We show that the nonimmunosuppressive analogues of the immunosuppressive drugs FK506, rapamycin and cyclosporin A promote neurite outgrowth both in PC12 cells and sensory neuronal cultures of dorsal root ganglia with potencies resembling their immunosuppressive homologues. Neurotrophic potencies of the immunophilin ligands resemble their potencies in binding to and inhibiting the rotamase activity of FKBP-12 of cyclophilin. Since nonimmunosuppressive immunophilin ligands, which are devoid of calcineurin inhibitory activity, are equally neurotrophic, inhibition of calcineurin activity is not the mediator of the neurotrophic effects. The immunophilin ligands are neurotrophic in intact animals. FK506 and L-685,818 (the C18-hydroxy, C21-ethyl derivative of FK506) treatment of rats with crushed sciatic nerves enhances both functional and morphologic recovery. The striking potency of these agents, their bioavailability and the dissociation of neurotrophic from immunosuppressant actions argue for their therapeutic relevance in the treatment of neurodegenerative diseases.
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Affiliation(s)
- J P Steiner
- Department of Neurobiological Research, Guilford Pharmaceuticals Inc., Baltimore, Maryland 21224, USA
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Steiner JP, Hamilton GS, Ross DT, Valentine HL, Guo H, Connolly MA, Liang S, Ramsey C, Li JH, Huang W, Howorth P, Soni R, Fuller M, Sauer H, Nowotnik AC, Suzdak PD. Neurotrophic immunophilin ligands stimulate structural and functional recovery in neurodegenerative animal models. Proc Natl Acad Sci U S A 1997; 94:2019-24. [PMID: 9050897 PMCID: PMC20035 DOI: 10.1073/pnas.94.5.2019] [Citation(s) in RCA: 258] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Although immunosuppressant immunophilin ligands promote neurite outgrowth in vitro, their neurotrophic activities are clearly independent of their immunosuppressive activity. In the present report, a novel nonimmunosuppressive immunophilin ligand, GPI-1046 (3-(3-pyridyl)-1-propyl (2S)-1-(3,3-dimethyl-1,2-dioxopentyl)-2-pyrrolidinecarboxylate+ ++) is described. In vitro, GPI-1046 bound to FK506 binding protein-12 and elicited neurite outgrowth from sensory neuronal cultures with picomolar potency with maximal effects comparable to nerve growth factor. In vivo, GPI-1046 stimulated the regeneration of lesioned sciatic nerve axons and myelin levels. In the central nervous system, GPI-1046 promoted protection and/or sprouting of serotonin-containing nerve fibers in somatosensory cortex following parachloroamphetamine treatment. GPI-1046 also induced regenerative sprouting from spared nigrostriatal dopaminergic neurons following 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine toxicity in mice or 6-hydroxydopamine (6-OHDA) toxicity in rats. The rotational abnormality in 6-OHDA treated rats was alleviated by GPI-1046. These neurotrophic actions in multiple models suggest therapeutic utility for GPI-1046 in neurodegenerative diseases.
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Affiliation(s)
- J P Steiner
- Department of Neurobiological Research, Guilford Pharmaceuticals Inc., Baltimore, MD 21224, USA
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Levy MH, Connolly MA, O'Brien RJ. Cigarette smoking as a risk factor for tuberculosis in young adults: a case-control study. Tuber Lung Dis 1996; 77:570. [PMID: 9039455 DOI: 10.1016/s0962-8479(96)90060-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Spector NM, Connolly MA, Garrity ER. Lung transplant rejection: obliterative bronchiolitis. Am J Crit Care 1996; 5:366-72. [PMID: 8870860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND More centers are performing lung transplants for a variety of pulmonary conditions. Chronic rejection, manifested as obliterative bronchiolitis, is the most common cause of late death (greater than 6 months after transplant) in this population. OBJECTIVES To review published literature on obliterative bronchiolitis to determine the current terminology and definition, pathophysiology, incidence, diagnosis, treatment, and outcome of this condition. DATA SELECTION A MEDLINE search was done using the medical subject headings of bronchiolitis obliterans and lung transplantation. Studies were selected based on sample size and reporting of obliterative bronchiolitis statistics. Sources that were not data-based discussions also were selected if they were comprehensive reviews or provided insight into relevant issues. SUMMARY Obliterative bronchiolitis terminology is not used consistently in the literature. It is an obstructive defect that affects the airways, causing progressive occlusion. Diagnosis is based on clinical findings or on histological analysis; early markers are sought, to aid in diagnosis. Incidence of obliterative bronchiolitis varies from 7% to 54%, with a mortality rate of 30% to 40%. Currently, enhanced immunosuppression is the treatment of choice, although research is being carried out to evaluate methods of inhibiting growth factor activity for use in future treatment strategies. CONCLUSIONS Obliterative bronchiolitis is a common complication in lung transplant recipients, and future research will focus on treatment and early diagnosis. Efforts are under way to standardize nomenclature and reporting of incidence and mortality rates.
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Affiliation(s)
- N M Spector
- Niehoff School of Nursing, Loyola University, Chicago, III, USA
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Abstract
BACKGROUND: More centers are performing lung transplants for a variety of pulmonary conditions. Chronic rejection, manifested as obliterative bronchiolitis, is the most common cause of late death (greater than 6 months after transplant) in this population. OBJECTIVES: To review published literature on obliterative bronchiolitis to determine the current terminology and definition, pathophysiology, incidence, diagnosis, treatment, and outcome of this condition. DATA SELECTION: A MEDLINE search was done using the medical subject headings of bronchiolitis obliterans and lung transplantation. Studies were selected based on sample size and reporting of obliterative bronchiolitis statistics. Sources that were not data-based discussions also were selected if they were comprehensive reviews or provided insight into relevant issues. SUMMARY: Obliterative bronchiolitis terminology is not used consistently in the literature. It is an obstructive defect that affects the airways, causing progressive occlusion. Diagnosis is based on clinical findings or on histological analysis; early markers are sought, to aid in diagnosis. Incidence of obliterative bronchiolitis varies from 7% to 54%, with a mortality rate of 30% to 40%. Currently, enhanced immunosuppression is the treatment of choice, although research is being carried out to evaluate methods of inhibiting growth factor activity for use in future treatment strategies. CONCLUSIONS: Obliterative bronchiolitis is a common complication in lung transplant recipients, and future research will focus on treatment and early diagnosis. Efforts are under way to standardize nomenclature and reporting of incidence and mortality rates.
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Connolly MA. Communicating with temporarily nonvocal patients. Perspect Respir Nurs 1995; 6:7-9. [PMID: 8705000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Patients in the intensive care unit (ICU) with compromised lung function often have excessive pulmonary secretions and have difficulty clearing mucus. A variety of pharmacotherapeutics have been used in an attempt to change the rate, amount, and viscosity of respiratory secretions. These drugs are known as mucokinetic or mucolytic drugs, but their efficacy remains controversial in the research literature. Most commonly used methods of mucolysis/mucokinesis include: bland aerosols (saline), pH adjustment (sodium bicarbonate), and disulfide disruption (N-acetylcysteine, MUCOMYST). Clinical research needs to be done on the use of recombinant human deoxyribonuclease (rhDNase) in ICU patients because recombinant human deoxyribonuclease affects only purulent secretions, which makes it a safe, easily tolerated compound. Nursing interventions in the control of mucus in the ICU patient needs to be re-examined in light of recent research where the efficacy of chest percussion was questioned, as was the use of saline bolus instillation before suctioning and the potential for dornase alfa.
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Connolly MA. Need for nursing research in the area of improving communication for mechanically ventilated patients. Am J Crit Care 1994. [DOI: 10.4037/ajcc1994.3.5.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Connolly MA. Need for nursing research in the area of improving communication for mechanically ventilated patients. Am J Crit Care 1994; 3:404. [PMID: 8000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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McCreadie RG, Connolly MA, Williamson DJ, Athawes RW, Tilak-Singh D. The Nithsdale Schizophrenia Surveys. XII. 'Neurodevelopmental' Schizophrenia: a search for clinical correlates and putative aetiological factors. Br J Psychiatry 1994; 165:340-6. [PMID: 7994503 DOI: 10.1192/bjp.165.3.340] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim was to examine in a population of schizophrenic patients the clinical correlates of 'neurodevelopmental' schizophrenia and their relationship to putative aetiological factors. METHOD Premorbid social adjustment, premorbid schizoid and schizotypal personality traits, and the obstetric history of 40 schizophrenic patients and their 102 sibs were assessed through interviews with their mothers. Patients' premorbid level of intelligence was assessed by the National Adult Reading Test and current symptoms by the Positive and Negative Syndrome Scale and the Subjective Deficit Syndrome Scale. RESULTS Patients had more schizoid and schizotypal traits than their sibs. They showed a deterioration in social adjustment between childhood and adolescence; sibs' social adjustment improved. There were statistically significant associations between current negative schizophrenic symptoms, premorbid deterioration in social adjustment, and schizoid and schizotypal personality traits, and between an early age of onset of illness and the same premorbid assessments. There was no evidence that patients with a family history of severe mental illness leading to hospitalisation, or a history of definite obstetric complications, had poorer premorbid functioning or more severe current symptoms. CONCLUSIONS We have confirmed clinical correlates of 'neurodevelopmental' schizophrenia but found no association between these and obstetric complications or a family history of severe mental disorder.
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McCreadie RG, Williamson DJ, Athawes RW, Connolly MA, Tilak-Singh D. The Nithsdale Schizophrenia Surveys. XIII. Parental rearing patterns, current symptomatology and relatives' expressed emotion. Br J Psychiatry 1994; 165:347-52. [PMID: 7994504 DOI: 10.1192/bjp.165.3.347] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A population of adult schizophrenic patients was assessed to discover how the patients viewed their childhood, whether their view differed from non-schizophrenic adults, and to determine any association between parental rearing practices as perceived by the patient, childhood personality as perceived by the mother, and current symptoms. Type and level of expressed emotion shown by parents towards patients was also examined. METHOD Parental attitudes, as perceived by 50 schizophrenic patients, were assessed by the EMBU scale. Patients' premorbid personality and social adjustment were assessed through interviews with patients' mothers by the Scale for the Assessment of Premorbid Schizoid and Schizotypal Traits and the Premorbid Social Adjustment Scale. Current symptoms were assessed by the Positive and Negative Syndrome Scale and Subjective Deficit Syndrome Scale. RESULTS Patients saw little difference between fathers' and mothers' attitudes. There was a positive correlation between parental rejection and overprotection, and a negative correlation between rejection and warmth. There were no significant correlations between parental rearing attitudes and patients' childhood personality; there was a significant correlation between parental attitudes and current symptoms. Rejection and overprotection were associated with more severe, warmth with less severe symptoms, especially so for positive schizophrenic symptoms and general psychopathology. Although there was no association between the general level of expressed emotion shown by the parent towards the adult patient, and patients' perceived parental rearing attitudes, parents with high expressed emotion on the basis of hostility had higher rejection scores on the parental rearing attitudes scale. CONCLUSIONS Schizophrenic patients saw their parents as showing much less warmth, and the severity of currents symptoms was associated with perceived parental rearing attitudes. The hostility component of high expressed emotion may be a parental trait which exists before the illness begins.
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Novotny EA, Bednar DL, Connolly MA, Connor JR, Stormann TM. Mutation of aspartate residues in the third extracellular loop of the rat B2 bradykinin receptor decreases affinity for bradykinin. Biochem Biophys Res Commun 1994; 201:523-30. [PMID: 8002982 DOI: 10.1006/bbrc.1994.1733] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two aspartates in the third extracellular loop of the rat B2 bradykinin (BK) receptor have been implicated as important residues for agonist binding. Asp268 and Asp286 were mutated to alanine residues and changes in agonist and antagonist binding affinity were examined. The IC50 value for BK as a competitor of [3H] NPC 17731 binding to the rat wild type receptor was 1.1 nM, while the Ala268 and Ala286 receptor mutants exhibited IC50 values of 19 nM and 28 nM, respectively. The Ala268Ala268 receptor mutant exhibited an IC50 for BK of 500 nM. These mutations had little effect on binding affinity when NPC 17761, a BK antagonist, was used to compete [3H] NPC 17731 binding. Electrophysiological examination of Xenopus oocytes expressing wild type or Ala268 Ala286 receptors confirmed the importance of the Asp268 and Asp286 residues for BK recognition. BK activated the mutant receptor with comparable efficacy relative to the wild type receptor, but a 1750-fold reduction in potency was observed.
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Affiliation(s)
- E A Novotny
- Scios Nova Inc., Department of Structural Biology, Baltimore, MD 21224-6522
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Abstract
One major psychosocial problem of mechanically ventilated patients is their inability to speak because of the cuffed endotracheal or tracheostomy tube obstructing the larynx and airflow. The authors analyze the research findings to suggest research-based strategies for communicating with ventilator patients.
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Yang P, Beaty TH, Khoury MJ, Liang KY, Connolly MA. Predicting intrauterine growth retardation in sibships while considering maternal and infant covariates. Genet Epidemiol 1989; 6:525-35. [PMID: 2777073 DOI: 10.1002/gepi.1370060407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Data on 6,210 full-term sibships (gestational age greater than 36 weeks) reconstructed from birth certificates registered in Maryland between 1980 and 1984 were used to study sibship aggregation and recurrence risk of intrauterine growth retardation (IUGR) while considering maternal and infant covariates. In this study, IUGR was defined as being below the 10th percentile for race-, sex-, and gestational-age-specific birth weight based on all births registered in Maryland during 1984. Maternal factors (race, age at delivery, marital status, amount of prenatal care, concurrent illnesses, and complications during pregnancy) and infant factors (congenital malformations and first born child or not) were used as covariates in a modified logistic regression model which allowed correlation among sibs. First-time mothers who were under age 30 years, unmarried, received too little prenatal care, or had any reported pregnancy complications were at high risk of delivering an infant with IUGR. Even given the effects of these risk factors, however, there was a significant correlation in risk among full sibs (r = .237 +/- .028), which, combined with information on risk factors, can be used to estimate sibling recurrence risk for IUGR.
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Affiliation(s)
- P Yang
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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Beaty TH, Self SG, Liang KY, Connolly MA, Chase GA, Kwiterovich PO. Use of robust variance components models to analyse triglyceride data in families. Ann Hum Genet 1985; 49:315-28. [PMID: 4073838 DOI: 10.1111/j.1469-1809.1985.tb01707.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A robust approach for analysis of variance components models is presented which does not rely on the assumption of multivariate normality for its validity. This approach uses the multivariated normal distribution as a 'working model' but obtains standard errors for the final estimators which do not depend on this underlying distribution. By using the observed variance in the first derivatives of the multivariate normal 'working model' to modify the conventional score test, hypotheses regarding specific components can also be tested without relying directly on the assumption of multivariate normality. A special case is presented where both the modified score test and the likelihood ratio test are equally robust, and simulated data are used to illustrate this situation. Measurements of triglyceride levels in 391 individuals in 60 families randomly selected from the membership of a health maintenance organization are used to illustrate this robust approach to variance components.
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