Responding to health care reform by addressing the institute of medicine report on the future of nursing.

The current health care environment has heightened the importance of achieving positive patient outcomes and excellent customer satisfaction. To remain competitive, health care organizations must adapt quickly to changing regulatory requirements, quality improvement initiatives, and customer expectations. To ensure nursing practice at the Saint Clare's Health System in Northwest New Jersey is at the forefront of leading change, the nursing staff has embraced the Institute of Medicine report The Future of Nursing: Leading Change.

Tensions and stresses of ellipsoidal chambers.

Equations for calculating wall tensions in an ellipsoidal chamber might be useful in analyses of elongated chambers whose transverse sections are not round, and they should be useful for examining the tension distribution associated with such shapes. Considering the forces changing a prolate spheroid (semiaxes a > b = c) into a general ellipsoid (semiaxes a > b > c) led to an equation for tensions at the poles of an ellipsoid. Considering the thickness distribution of a chamber of uniform average stress led to an equation for the average of orthogonal tensions at any point on an ellipsoidal chamber.

Mechanical characteristics of tachycardia-induced left-ventricular failure as evaluated in isolated dog hearts.

Left ventricles of control dog hearts and dog hearts failing due to chronic tachycardia were examined in vivo by echocardiography for systolic function and size, then subsequently studied with an isolated-heart system (artificial perfusion, artificial loading). During 3 weeks of tachycardia (250 bt/min), area ejection fraction fell by 58%, while end-diastolic transverse area increased by 56% (measurements at 120 bt/min). Judging from post-perfusion left-ventricular weights, the dilation occurred with no hypertrophy, raising the question whether the failure model may be associated with anabolic dysfunction.

Characteristics of left-ventricular isovolumic pressure waves in isolated dog hearts.

The peak pressure which a chamber would develop in isovolumic contraction at end-diastolic distention (peak source pressure) is an expression of contractile vigor and a determinant of systolic performance. One can predict source pressure of an ejecting beat by fitting its isovolumic phases with a model isovolumic-wave function. Characteristics of the left-ventricular isovolumic pressure wave (amplitude, duration, shape) were studied in isolated, perfused, artificially loaded dog hearts, where strictly isovolumic conditions could be obtained over a wide range of cavity volumes at constant heart rate and approximately constant contractile state.