Lisa Carozza

Implementing Information Technology in a Behavioral Health Setting

The art and practice of nursing in todays health care arena is becoming increasingly complex. One of the newest challenges in the field of behavioral health is the integration of quality health care with information technology. The authors of this paper examine four emerging aspects of information technology: the electronic medical record, automated medication distribution systems, computerized charting, and hand-held computers. The benefits, costs, uses of these technologies, and the potential problems they can provide in the field of behavioral health are discussed. Implications for nursing practice also are explored.

Using non-invasive quantitative echocardiography during weaning trials to assess left ventricular recovery on mechanical assist devices

compare pulsatile and nonpulsatile flow generated by LVADs with outflow to the ascending aorta and descending aorta. Methods: An in vitro mock circulatory loop, driven by either a pulsatile or a nonpulsatile LVAD was anastomosed to transparent aortic models at either ascending or descending aortic position. The aortic valve was kept closed modeling no native cardiac output. Normal saline was used as a blood substitute. Methylene blue dye was injected to illustrate flow patterns in the ascending aorta and aortic arch. Dye washout time was used as a marker of flow stagnation and potential thrombogenicity. Cardiac output, afterload and coronary flow were measured. Results: Dye washout times for 5 L/min flow rate were 2.0 0.8, 2.0 0.7, 5.0 0.8, and 8.0 4.4 sec for pulsatile ascending (PA), continuous ascending (CA), pulsatile descending (PD), and continuous descending (CD), respectively. Coronary flow was 265, 312, 310, and 286 ml/min for PA, CA, PD, and CD, respectively. Dye washout times for 4 L/min flow rate were 3.0 1.0, 3.0 0.8, 14.0 3.8, and 25.0 9.1 sec for PA, CA, PD, and CD, respectively. Coronary flow was 210, 240, 225, and 233 ml/min for PA, CA, PD, and CD, respectively. Conclusion: LVAD descending aortic anastomosis and retrograde aortic flow is associated with significantly increased (P 0.001) flow stagnation in the ascending aorta. This may increase the risk for thromboembolism in patients solely relying on retrograde aortic flow. There were no differences in coronary flow across the study groups.