Pediatric mechanical circulatory support.

Over the past two decades clinicians and researchers have sought to bring mechanical circulatory support (MCS) to pediatric patients with heart failure. ECMO, IABPs, and VADs have all been used in infants and children as a bridge to myocardial recovery or as a bridge to transplant. However, until recently, a commitment by industry, government, and researchers towards the development of pediatric MCS has not been present, especially in the United States. Advancements in adult VAD design to smaller, quieter, and fully implantable pumps capable of complete outpatient support have sparked curiosity in the application of this technology to children. Also, the increasing success of palliating congenital heart disease is creating an ever-growing cohort of children and adolescents with heart failure. These changing demographics and technological advances have caused a refocus of attention. This is most clearly demonstrated by the international use of several established MCS pediatric and neonatal systems, by the FDAOs increasing proclivity to allow the use of international pediatric VADs in the USA, and by the recent National Heart, Lung, and Blood Institute funding of several institutions to develop pediatric VADs. This review describes the different aspects of pediatric MCS including indications, the features of the various VADs, and their current application in children worldwide.

Using supportive services to manage cost while improving quality.

Supportive services have traditionally been viewed as secondary to the skilled services in home care. Yet increasingly these supportive services can be more important to clients than many organizations recognize--and more important in managing costs as well.

AIDS patient writes final chapter of his life--on his own terms.

Care for persons with AIDS involves complicated and emotional factors. The many players in such cases--from physicians to home care aides to insurance companies--may confuse the most important issue: the patient's care. This case study illustrates how smoothly such a potentially difficult situation can proceed when all players share the same values.

Designing a road map for success: through common values and mission.

Employees must know the goals of an organization if they are to be expected to work toward their accomplishment. Concerned Care, Inc., found that through the identification of its values and the development of a mission statement, it was able to design a road map for its employees to follow, which led to success for the company.