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Introduction: Less-invasive hemodynamic monitoring (eg, esophageal doppler monitoring [EDM] and arterial pressure contour analysis, FloTrac) is increasingly used as an alternative to pulmonary artery catheters (PACs) in critically ill intensive care unit (ICU). Hypothesis: The decrease in use of PACs is not associated with increased mortality. Methods: Five-year retrospective review of 1894 hemodynamically monitored patients admitted to 3 surgical ICUs in a university-affiliate, tertiary care urban hospital. Data included the number of admissions, diagnosis-related group discharge case mix, length of stay, insertion of monitoring devices (PAC, EDM, and FloTrac probes), administered intravenous vasoactive agents (β-predominant agonists—dobutamine, epinephrine, and dopamine; vasopressors—norepinephrine and phenylephrine), and mortality. Data from hospital administrative databases were compiled to create patient characteristic and monitoring variables across a 5-year time period, 2005 to 2009 inclusive. Chi-square for independent proportions, 1-way analysis of variance, and Kruskal-Wallis tests were used; tests for trend were conducted. An α level of .05 was considered significant. Statistical Package for the Social Sciences v14 was used for all statistical testing. Results: There was a significant change in the type of hemodynamic monitors inserted in 2 of the 3 surgical ICUs (in the general surgery and neurointensive care but not in the cardiac ICU) from PACs to less-invasive devices (FloTrac or EDM) during the 5-year study period ( P < .001). There was no change in mortality rate over the time period ( P = .492). There was an overall increase in the proportion of monitored patients who received intravenous vasoactive agents ( P < .001) with a progressive shift from β-agonists to vasopressors ( P < .002). Multivariate analyses indicated that age, case mix, and use of vasoactive agents were all independent predictors of inhospital mortality ( P = .001) but that type of monitoring was not ( P = .638). Conclusions: In a 5-year period, the decreased insertions of PACs were replaced by increased utilization of less-invasive hemodynamic monitoring devices. This change in practice did not adversely impact mortality.

Effective implementation of service coordination in early intervention, as mandated by the Individuals with Disabilities Education Act, remains a challenge for most states. The present study provides a better understanding of the various aspects of the policy infrastructure that undergird service coordination across the United States. Data from a national survey of all state Part C coordinators contained critical variables that are used to describe three dimension of the policy infrastructure—responsibilities of the service coordinator, the document used to guide service coordination (Individualized Family Service Plan), and policies that facilitate a comprehensive and interagency coordinated service system. The results indicated that in general, most states do not have a sufficient policy infrastructure to support the implementation of effective service coordination.

This article presents a descriptive analysis of the early intervention services received by a group of 68 toddler-age children. The children were 30 months of age and early intervention services were delivered within childcare centers. Data were collected across family, child, and service characteristics. Results suggested that the children were receiving services distributed across special instruction, speech therapy, occupational therapy, and physical therapy delivered primarily at the childcare center. The families consisted mostly of two-parent households, having at least one parent employed. The Individual Family Service Plans primarily contained child-focused outcomes. Recommendations for service delivery improvements and future research are included.

The flowering of program evaluation as a research technique took place in the 1960s and 1970s. In those years, the programs of the Great Society exemplified a confidence in the future, a faith that change was possible, and a conviction that the beneficial effects of programs could be augmented by using research findings to provide rational bases for decision-making. The belief in rationality helped evaluation develop as a quasi-scientific research endeavor, whose primary purpose was use of results more than the accumulation of knowledge (Bander et al., 1982). This paper (1) addresses the question of utilization, first by describing early efforts for its increase, and, then by using a case example to illustrate some applications; and (2) argues that evaluation is an exercise in power within a program or organization.

The initial experiences of a family reunification program are reported. Along with preliminary data, several provocative issues are discussed, including goal setting, use of service agreements, foster families that abuse, the child's interests, and program success and burnout.