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Biomedical subjects

N H Miller

Publications and source records attributed to N H Miller.

48 records · Page 3Linked to original sources
PubMed1984

Home versus group exercise training for increasing functional capacity after myocardial infarction.

To evaluate the efficacy of exercise training for increasing functional capacity in the 6 months after clinically uncomplicated myocardial infarction, 198 men 52 +/- 9 years of age participated in a training study. They were randomly assigned to one of four exercise protocols: 8 to 26 weeks of training at home (group 1, n = 66) or in a group program (group 2, n = 61) following treadmill testing performed 3 weeks after infarction, treadmill testing at 3 weeks without subsequent training (group 3, n = 34), and treadmill testing for the first time at 26 weeks (control, n = 37). At 26 weeks functional capacity was significantly higher in patients training at home or in a group program than that in patients without training or in control patients: 8.1 +/- 1.5, 8.5 +/- 1.3, 7.5 +/- 1.8, and 7.0 +/- 1.7 METs, respectively (p less than .05 and p less than .001). No significant differences in functional capacity were noted between patients training at home and those in a group program. No training-related complications occurred. Home and group training are equally effective in increasing functional capacity of low-risk patients after myocardial infarction.

Aged↗
PubMedDate not supplied

Chronic disease management: treating the patient with disease(s) vs treating disease(s) in the patient.

The treatment of chronic disease is often complicated by the coexistence of multiple medical conditions and by the presence of social and psychological impediments. The needs posed by patients with chronic disease are overwhelming the capacity of the American health care system. Alternative disease management systems that rely on specially trained nurse case managers to implement detailed clinical protocols, including drug algorithms, have shown efficacy in managing chronic medical conditions, singly and in combination. By fostering integration of care across subspecialty and medical-social boundaries, such systems enable treatment of the patient with disease(s), not simply treatment of disease(s) in the patient. Working closely with primary care physicians, often by telephone-mediated interaction with patients, nurse case managers may take an expanded role in meeting the challenges posed by chronic disease.

Case Management↗
PubMedDate not supplied

Women's initiative for nonsmoking (WINS) II: the intervention.

Women's Initiative for Nonsmoking (WINS) is a randomized clinical trial designed to test the efficacy of a nurse-managed smoking cessation and relapse prevention intervention designed specifically for women. The WINS intervention is rooted in social learning theory, specifically that of self-efficacy. It is a multimedia approach that provides education, counseling, and telephone follow-up that meet the smoking cessation intervention guidelines established by the Agency for Health Care Policy and Research. The WINS intervention has been successfully implemented in more than 140 women and has proven to be feasible and well accepted by both the women and their health care providers. Although the intervention in the protocol-driven randomized clinical trial was begun in the hospital, it is anticipated that nurses in any setting, inpatient or outpatient, who serve populations at risk for cardiovascular disease, peripheral vascular disease, lung cancer, or pulmonary disease could successfully provide the intervention.

Cardiovascular Diseases↗
PubMedDate not supplied

National Survey on Gender Differences in Cardiac Rehabilitation Programs. Patient characteristics and enrollment patterns.

PURPOSE: Cardiac rehabilitation (CR) programs have been shown to promote numerous health benefits among patients with active coronary heart disease (CHD), but little is known about the percentage of eligible CHD patients who enroll in CR. METHODS: A survey was performed of 500 randomly chosen CR programs in operation in the United States during 1990. Patient characteristics and enrollment data were combined with data from the 1990 National Hospital Discharge Survey to estimate the percentage of eligible patients who participated in early outpatient (Phase II) CR programs after myocardial infarction (MI), after coronary angioplasty (PTCA), or after coronary artery bypass surgery (CABS). RESULTS: Completed surveys were returned by 163 programs (32.6%) with information on 1,322 women and 1,418 men who enrolled in their programs in 1990. Women were older, more likely to be single, and had more traditional CHD risk factors than men. Only a minority of MI, PTCA, and CABS survivors enrolled in CR programs (10.8%, 10.3% and 23.4%, respectively). Enrollment was particularly low for post-MI and post-CABS women as compared with men: 6.9% versus 13.3% (P < .001), and 20.2% versus 24.6% (P < .001), respectively. Enrollment was generally lowest for nonwhites, those over age 65, and those living in the southern United States. CONCLUSIONS: Cardiac rehabilitation programs are used by a minority of eligible patients, particularly among women, nonwhites, and the elderly. To meet newly released national guidelines that recommend CR services for most patients recovering from MI, PTCA, or CABS, and to still contain costs, new methods need to be explored that can expand the delivery of CR services in clinical settings.

Aged↗
PubMedDate not supplied

The effect of a home-based, case-managed, multifactorial risk-reduction program on reducing psychological distress in patients with cardiovascular disease.

BACKGROUND: This study examined the effects of a nurse-case-managed, multifactorial, risk-reduction program on psychological distress among patients after myocardial infarction (MI). METHODS: Five hundred eighty-five men and women aged 70 years or younger, who were hospitalized for acute MI in one of five San Francisco Bay Area hospitals, were randomized to receive a nurse-managed, home-based, multifactorial risk-reduction program (n = 293) or usual care (n = 292). The program, which began in the hospital, included a brief screen for five areas of psychological distress with further evaluation if indicated, monitoring during the follow-up phone calls, and referral for mental health treatment if needed. Patients were assessed with single-item scales at baseline, and at 6 and 12 months. Separate analyses were performed for patients with moderate-to-severe levels on the psychological distress domains and for those with low levels. RESULTS: There was a significant reduction in the psychological distress variables for all patient groups between baseline and 12 months. The program had a significant effect on reducing anxiety in the patient group with low levels of anxiety and reducing anger in the patient group with frequent episodes of anger but, overall, the treatment and control groups showed equal levels of improvement. CONCLUSION: Among patients post-MI without complications, psychological distress decreases significantly during the 12 months after MI.

Aged↗
PubMedDate not supplied

The foot in Marfan syndrome: clinical findings and weight-distribution patterns.

The feet of Marfan patients are typically described as pes planovalgus. We evaluated the single-leg-stance footprint of 124 feet in 63 patients with the Marfan syndrome by using pressure-sensitive film and a Harris mat. Forty feet in 21 people with no history of foot problems were evaluated as normal controls. The medial and lateral aspects of the fore-, mid-, and hindfoot were assessed. The midfoot was further analyzed by dividing the medial midfoot force by the total midfoot force. The mean medial midfoot force/total midfoot force (MM/TM) in the control population was 11.1% (SD, 6.5%). Pes planus was defined as the MM/TM force > 24.0% (mean + 2 SD). The mean MM/TM force in the Marfan group was not statistically different (16.0%) from controls. The distribution, however, revealed two distinct types of weight-bearing patterns. Of the Marfan group, 74.8% had medial forces within the standard distribution of the normal control population. Only 25.2% of the Marfan patients had forces that were outside the range of normal midfoot forces and were defined as pes planus. Analysis of the patient's ligamentous laxity and the foot function in the Marfan population revealed no statistically significant correlation to the type of weight-bearing pattern of the foot.

Adult↗