Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease

Background  Cardiac output is the fundamental determinant of peripheral blood flow however; optimal regional tissue perfusion is ultimately dependant on the integrity of the arterial conduits that transport flow. A complete understanding of tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations. Multi-channel electrical bioimpedance (MEB) measures cardiac output and peripheral flow simultaneously. Objectives  Assessment of the accuracy of MEB to measure cardiac output in patients with clinical heart failure (group 1) and to measure regional arterial limb flow in patients with exertional leg pain clinically thought to have peripheral arterial disease (group 2). Methods  Cardiac output was measured by MEB in 44 patients with moderate to severe clinical heart failure (group 1) and was compared to a cardiac output measured by 2D-Echo Doppler. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in another group of 25 patients with exertional leg pain clinically thought to be claudication (group 2). The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index). Results  There was excellent correlation between the mean cardiac index by MEB (2.01 l/min/m²) and by 2D-Echo Doppler (2.06 l/min/m²) and bias and precision was 0.05 (2.4%) and ±0.48 l/min/m² (±23%), respectively. The correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (P < 0.05). Conclusions   MEB accurately measures cardiac output in patients with moderate to severe clinical heart failure and accurately measures regional arterial limb flow in patients with peripheral arterial disease. Stanley AWH, Herald JW, Athanasuleas CL, Jacob SC, Bartolucci AA, Tsoglin AN. Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease     

Invited Paper: Teaching Nursing Diagnosis to Increase Utilization After Graduation

BACKGROUND. The majority of nursing programs identify the nursing process and diagnosis as critical elements in their curricula, yet it is often absent in classroom and clinical discussions. The failure of faculty to integrate the nursing process and diagnoses into learning experiences creates students spending endless hours creating a care plan document that requires little critical thinking, a document that does not improve the student's likelihood of utilizing nursing diagnosis after graduation. PURPOSE. This paper would outline the educational barriers for integration of these concepts into practice. DISCUSSION. Classroom and clinical strategies that guide the student to focused learning on nursing diagnoses and utilize standardized predicted care plans can produce desired curriculum outcomes, and ultimately, practice utilization will be presented.     

Anemia and its impact on function in nursing home residents: What do we know?

Purpose: To provide the advanced practice nurse (APN) information on the prevalence and causes of anemia in elderly nursing home (NH) residents, in order to affect diagnostic and management strategies that may help improve physical function and mobility outcomes.
Data Sources: Literature review of current peer-reviewed research articles.
Conclusions: In the United States, the prevalence of anemia increases with advancing age, and are reported to be much higher among older NH residents than among community-dwelling older adults. Causes of anemia among the elderly are often multifactorial. Older individuals with anemia, including mild anemia and even low normal level, have demonstrated lower muscle strength, physical function, mobility, and increased morbidity and mortality outcomes.
Implications for Practice: Given the potentially significant relationship between anemia and physical performance outcomes among NH residents, gaining a better understanding will help guide future evidence-based care by allowing the APN an opportunity to tailor both medical and restorative care interventions. Because anemia is a potentially modifiable condition, intervention may preserve, limit, or reverse functional impairment and/or disablement, and allow for maximal functional independence.     

Helping Infertile Couples Explore the Option of Adoption

Adoption often is considered an ideal option for infertile couples. This article presents topics health-care professionals should address when discussing adoption with infertile couples and delineates interventions for anticipatory guidance once they decide to adopt.