BACKGROUND: This study was undertaken to evaluate the potential benefits of using an electromagnetic detection system to guide the intraoperative placement of chronic venous access devices (CVADs). STUDY DESIGN: An electromagnetic detection system was used to guide catheter placement during 54 procedures. Surgery and radiation exposure times were recorded. An oncology nursing follow-up questionnaire assessed device function. A cost analysis was performed. Outcomes were compared to similar data from a fluoroscopic historical control group. RESULTS: Eight study patients required intraoperative fluoroscopy; in 46 procedures (85%) the electromagnetic detection system was the sole modality employed to guide CVAD placement. One line was subsequently found in the internal mammary vein (2% false negative rate). Mean surgery times for placement of CVADs were 79.5 and 84.5 minutes for the study and control groups (p = NS). Mean radiation exposure rates were 0.16 and 0.86 minutes per patient for the study and control groups (p < 0.01). There was no significant difference in device function between groups. Major complications in the study group were rare. Mean cost of CVAD placement was $1993 and $2517 for the study and control groups (p = 0.005), respectively. CONCLUSIONS: The use of the electromagnetic detection system resulted in accurate placement of chest wall CVADs in the majority of patients. This resulted in significant reductions in radiation exposure and cost of CVAD placement.

Catheterization, Central Venous↗

PubMedDate not supplied

Development of an oncology services performance improvement team.

Baystate Medical Center is a 750-bed tertiary-care referral center in western Massachusetts. In 1995 Baystate reorganized the structure of its quality assurance (QA) program from an individual departmentally based QA committee structure to a series of multidisciplinary service-line performance improvement teams. The new approach sought to implement total quality management techniques that had been proven effective in major industrial settings but were not widely applied in the healthcare sector. The oncology services performance improvement team is cochaired by an attending surgical oncologist and the nursing supervisor of a dedicated inpatient oncology unit. Its membership comprises a broad spectrum of oncology subspecialists and allied support staff. The team supports multiple performance improvement initiatives, including analyses of various cancer-related outcomes (e.g., patient satisfaction, morbidity and mortality data) and peer review analysis. Systems issues not falling under the aegis of the oncology services team are referred to other service-line teams. The performance improvement activities are carefully designed to meet the needs of the facility's patient population and the accreditation requirements of the Joint Commission on Accreditation of Healthcare Organizations and the American College of Surgeons Commission on Cancer.

Accreditation↗

PubMedDate not supplied

A weekly group meeting for children on a pediatric ward: therapeutic and practical functions.

The multiple sources of psychological stress to the hospitalized child are reviewed with references to the literature. The Hahnemann Pediatric Ward and patient population are described as are the functions of a weekly group meeting for school aged hospitalized children led by a child psychiatrist. Efforts are made to use knowledge gained from the children for therapeutic purposes within the group as well as for teaching the inpatient pediatric staff how the hospitalized child's behavior reflects his inner thoughts and feelings. Aspects of the children's behavior and verbal productions in the group are discussed from a psychodynamic viewpoint. Conflict, ambivalence, fantasy distortion, denial and displacement are exemplified, as is the children's ever-present need to simultaneously express, defend against and master anxiety. Questions are raised about outcome and future avenues of investigation.

Attitude to Health↗