Hospice care in the long term care facility.

Health care today is practiced in a very different world. It is rare that the lone provider can be successful keeping pace with Medicare regulations, the Joint Commission Accreditation of Healthcare Organizations (JCAHO) recommended practices, Medicaid rules, efforts by nationwide lobbying groups, the American Association Retired Persons (AARP), and changing political winds associated with threats to long standing methods of reimbursement. As partners, the professional providers of long term care and the hospice professionals can join in a supportive relationship to enhance care to the terminally ill and put to rest any notion that either is a hindrance to this end.

Videothoracoscopy: a new perioperative challenge (continuing education credit).

1. The four cannula videothoracoscopic technique is generally used. This method affords a sufficient visual field and allows an excellent "two-handed" approach. 2. Videothoracoscopy is not for every patient; careful patient selection is important. It is also necessary to be able to develop and maintain a pneumothorax for a successful procedure. 3. The advantages of videothoracoscopy include reduced morbidity and mortality, less pain, decreased length of hospitalization, lowered health care costs, decreased blood loss, and decreased postoperative wound infections.