What's your approach to window management on Windows?

I often have many applications running simultaneously on my Windows desktop with some applications having several Windows open.

I've never been totally happy with Window management on Windows (especially after spending time using OS X and getting familiar with Expose and Mission Control on OS X). I've tried a few Expose/Mission Control clones but have not been happy with any of them.

At the moment I just use the built in alt-tab and aero peak.

What's your approach to window management? Are you satisfied with the built in options?, or do you use 3rd party utilities?