40 Wright Street Wing Emergency Services
Palmer MA 01069
Medical School: Vanderbilt University School Of Medicine - 1996
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 220254
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Awards & Recognitions
Dr. Robert Spence is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:99291||Description:Critical care first hour||Average Price:$651.00||Average Price Allowed
|HCPCS Code:99285||Description:Emergency dept visit||Average Price:$459.00||Average Price Allowed
|HCPCS Code:99284||Description:Emergency dept visit||Average Price:$338.00||Average Price Allowed
|HCPCS Code:99283||Description:Emergency dept visit||Average Price:$192.00||Average Price Allowed
|HCPCS Code:99282||Description:Emergency dept visit||Average Price:$111.00||Average Price Allowed
|HCPCS Code:93010||Description:Electrocardiogram report||Average Price:$42.00||Average Price Allowed
HCPCS Code Definitions
- Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.
- Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.
- Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician physicians, or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function.
- Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
- Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.
- Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only
Medical Malpractice Cases
Medical Board Sanctions
Cardiovascular Disease (Cardiology)
*These referrals represent the top 10 that Dr. Spence has made to other doctors
Draft Genome Sequence of Enterococcus faecalis Strain PF3, Isolated from Adelie Penguin Feces from Antarctica. - Genome announcements
Enterococcus faecalis is one of the leading causes of nosocomial infections and is a common commensal organism in humans and other animals. In this study, we report a draft genome sequence for the E.Â faecalis strain PF3, isolated from AdÃ©lie penguin feces collected from Warriner Island, Antarctica.
Encapsulating peritoneal sclerosis - a 5 year experience. - The Ulster medical journal
Encapsulating peritoneal sclerosis - A 5 year experience.Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening condition, characterised by a progressive, intra-abdominal inflammatory process resulting in fibrotic visceral constriction. We report the aetiology, management, and outcome of EPS in Belfast.All patients diagnosed with EPS in Belfast over the past 5 years are included. Presentation, aetiology, imaging, pathology, and outcome are retrospectively analysed and reported.7 patients (4 males) were identified with EPS with a mean age 54 years (range 33-69). Aetiology included peritoneal dialysis (3), radiation enteritis (1), peritoneal dialysis and radiation enteritis (1), tuberculosis, cirrhosis, and beta-blocker use (1), infected aorto-bifemoral graft (1). Of the 7 patients, 5 underwent definitive surgery. Bowel conserving surgery (laparotomy, division of adhesions, excision of membrane) was performed in 4 patients. One patient required an ileocaecal resection for radiation enteritis. Median pre-operative and post-operative hospital stay were 25 and 62 days respectively. Three patients required total parenteral nutrition (TPN) pre-operatively, 3 patients post-operatively; with 4 of the 7 patients discharged on TPN. 5 out of 7 patients are alive at median follow-up of 24 months. There was no 30-day in-hospital mortality.Patients with EPS often require parenteral nutrition before and after surgery. Peritoneal dialysis is a major risk factor for the development of EPS but other aetiologies should be considered. These patients have multiple co-morbidities, and operations for EPS are challenging with a high risk of peri-operative complications. Therefore these patients are best managed in a specialised unit with experience in intestinal failure surgery and access to a multi-disciplinary nutrition support team.
Overview of the investigation and management of cystic neoplasms of the pancreas. - Digestive surgery
Cystic neoplasms of the pancreas contribute to 10-20% of pancreatic tumours. Malignant cystic tumours of the pancreas behave similar to adenocarcinomas and thus warrant aggressive management. However, certain benign cystic neoplasms do not require operative intervention. It is, therefore, important to differentiate benign lesions from malignant lesions and from those with malignant potential.To provide an overview of the role of radiological investigations in the management of cystic neoplasms of the pancreas, with emphasis on the characteristic features of aggressive tumours. The role of different imaging modalities is discussed, and an investigative algorithm suggested.A literature review was carried out on Medline, Cochrane library, and PubMed using the MeSH terms 'pancreas' and 'cysts' to source relevant papers. Search criteria were limited to English literature, meta-analyses, systematic reviews, prospective and retrospective case series, published during or after 1998.Each pancreatic cystic lesion has characteristic radiological findings. However, the diagnostic accuracy of individual imaging techniques is still limited. A combination of imaging modalities is essential for preoperative diagnosis. CT complemented by endoscopic ultrasound and cyst fluid analysis appears to be the most promising investigation in diagnosing cystic neoplasms. Follow-up with serial imaging is useful for lesions of uncertain aetiology.Copyright Â© 2011 S. Karger AG, Basel.
Association of increasing burn severity in mice with delayed mobilization of circulating angiogenic cells. - Archives of surgery (Chicago, Ill. : 1960)
To perform a systematic exploration of the phenomenon of mobilization of circulating angiogenic cells (CACs) in an animal model. This phenomenon has been observed in patients with cutaneous burn wounds and may be an important mechanism for vasculogenesis in burn wound healing.We used a murine model, in which burn depth can be varied precisely, and a validated culture method for quantifying circulating CACs.Michael D. Hendrix Burn Research Center, Baltimore, Maryland.Male 129S1/SvImJ mice, aged 8 weeks, and 31 patients aged 19-59 years with burn injury on 1% to 64% of the body surface area and evidence of hemodynamic stability.Burn wound histological features, including immunohistochemistry for blood vessels with CD31 and alpha-smooth muscle actin antibodies, blood flow measured with laser Doppler perfusion imaging, and mobilization of CACs into circulating blood measured with a validated culture technique.Increasing burn depth resulted in a progressive delay in the time to mobilization of circulating CACs and reduced mobilization of CACs. This delay and reduction in CAC mobilization was associated with reduced perfusion and vascularization of the burn wound tissue. Analysis of CACs in the peripheral blood of the human patients, using a similar culture assay, confirmed results previously obtained by flow cytometry, that CAC levels peak early after the burn wound.If CAC mobilization and wound perfusion are important determinants of clinical outcome, then strategies designed to augment angiogenic responses may improve outcome in patients with severe burn wounds.
Using ordinal logistic regression to evaluate the performance of laser-Doppler predictions of burn-healing time. - BMC medical research methodology
Laser-Doppler imaging (LDI) of cutaneous blood flow is beginning to be used by burn surgeons to predict the healing time of burn wounds; predicted healing time is used to determine wound treatment as either dressings or surgery. In this paper, we do a statistical analysis of the performance of the technique.We used data from a study carried out by five burn centers: LDI was done once between days 2 to 5 post burn, and healing was assessed at both 14 days and 21 days post burn. Random-effects ordinal logistic regression and other models such as the continuation ratio model were used to model healing-time as a function of the LDI data, and of demographic and wound history variables. Statistical methods were also used to study the false-color palette, which enables the laser-Doppler imager to be used by clinicians as a decision-support tool.Overall performance is that diagnoses are over 90% correct. Related questions addressed were what was the best blood flow summary statistic and whether, given the blood flow measurements, demographic and observational variables had any additional predictive power (age, sex, race, % total body surface area burned (%TBSA), site and cause of burn, day of LDI scan, burn center). It was found that mean laser-Doppler flux over a wound area was the best statistic, and that, given the same mean flux, women recover slightly more slowly than men. Further, the likely degradation in predictive performance on moving to a patient group with larger %TBSA than those in the data sample was studied, and shown to be small.Modeling healing time is a complex statistical problem, with random effects due to multiple burn areas per individual, and censoring caused by patients missing hospital visits and undergoing surgery. This analysis applies state-of-the art statistical methods such as the bootstrap and permutation tests to a medical problem of topical interest. New medical findings are that age and %TBSA are not important predictors of healing time when the LDI results are known, whereas gender does influence recovery time, even when blood flow is controlled for.The conclusion regarding the palette is that an optimum three-color palette can be chosen 'automatically', but the optimum choice of a 5-color palette cannot be made solely by optimizing the percentage of correct diagnoses.
The challenge of reconstruction for severe facial burn deformity. - Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses
This article presents the story of the development of an expanded transposition flap that evolved from a desire to optimally reconstruct facial burn deformities. The story spans 25 years and demonstrates how an algorithm was developed from its use, and how the algorithm is used to analyze large facial burn deformities and provide a reconstructive surgical decision making tree. The experience suggests that versatility, reliability, and minimization of the donor site defect and reconstructive time are all benefits of this approach.
Case report: treatment of open femoral shaft fracture in a severely burned patient. - Eplasty
To present a case report of a patient with an open fracture and severe burns and review the literature.The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture. He later underwent multiple burn excision procedures with allograft and autograft skin coverage. The wound over the fracture was treated with dressing changes. The fracture was treated with nail exchange and bone grafting for atrophic nonunion.The patient was returned to full weightbearing and good function with a fully healed femur.Treatment of open fractures in burn patients should be tailored to the specific needs of the individual; they should be reduced and stabilized via internal fixation at the earliest opportunity and should be managed by minimizing wound colonization through successive debridement, wound care, and consideration of flap coverage.
An algorithm for total and subtotal facial reconstruction using an expanded transposition flap: a 20-year experience. - Plastic and reconstructive surgery
Reconstruction of major facial soft-tissue deformities and deficits is a continuing challenge for surgeons who wish to reliably restore facial function and appearance. A primary problem is deficiency of well-matched donor skin. Others include the unique characteristics of facial skin, the fine anatomical nuances, and the unique functional demands placed on the face making reconstruction difficult. The author presents an algorithm developed for total and subtotal reconstruction of the face using an expanded shoulder transposition flap as a key element.Expanded shoulder transposition flaps have been used since 1986 for head and neck resurfacing. An algorithm using the expanded shoulder transposition flap as a key element was developed for total and subtotal resurfacing of the face. The validity of this approach was evaluated by clinical results over 20 years. During that time, expanded shoulder transposition flaps were used 58 times in 41 patients ranging in age from 2 to 62 years.With the expanded shoulder transposition flap as its central component, the algorithm proved remarkably reliable and reproducible in resurfacing the peripheral facial aesthetic units with the main flap, and the pedicle skin often used for grafting the central face with its finer features. The donor site of the flap is closed primarily.This study examines the experience using an algorithm developed with the expanded shoulder transposition flap for major facial reconstruction. The experience suggests that the algorithm provides versatility and reliability; minimizes the donor-site defect; and is well within the skill, patience, and courage of most reconstructive surgeons.
Expanded transposition flap technique for total and subtotal resurfacing of the face and neck. - Journal of burns and wounds
The reconstruction of major burn and other deformities resulting from significant soft tissue deficits of the face and neck is a continuing challenge for surgeons who wish to reliably restore facial function and aesthetic appearance. A primary problem is deficiency of well-matched donor skin. Other problems include the unique characteristics of facial skin, the fine anatomic nuances, and the unique functional demands placed on the face. This article describes an expanded shoulder transposition flap that can provide a large amount of both flap and full-thickness skin graft for total and subtotal reconstruction of the face.An expanded shoulder transposition flap has been used since 1986 for head and neck resurfacing 58 times in 41 patients ranging in age from 2 to 62 years. The details of the technique and the results of the flap including complications are described.The flap proved remarkably reliable and reproducible in resurfacing the peripheral facial aesthetic units. The pedicle skin is often used for grafting of the central face with its finer features. The donor site of the flap is closed primarily.Twenty years' experience with expanded transposition flaps has shown it to be reliable and versatile in the reconstruction of major soft tissue deficits of the face and neck. It is a technique that provides economy of tissue, versatility, and is well within the skill, patience, and courage of most reconstructive surgeons.
Depression in burn reconstruction patients: symptom prevalence and association with body image dissatisfaction and physical function. - General hospital psychiatry
This study investigated the prevalence and the clinical correlates of symptoms of depression among burn reconstruction patients.A sample of 224 burn reconstruction patients completed the Beck Depression Inventory (BDI), the SF-36 Health Survey and the Satisfaction with Appearance Scale.The prevalence of at least mild to moderate symptoms of depression (BDI > or =10) was 46%. Female patients were disproportionately represented in this burn reconstruction population (46%) compared to all survivors from the burn center (29%; P<.001) and compared to a national sample of burn survivors (27%; P<.001). Compared to males, female patients presented for consultation much longer after a burn injury (P<.001), tended to have smaller burns (P=.06) and were less likely to have facial burns (P=.08). Depressive symptoms were largely predicted by body image dissatisfaction (beta=.58; P<.001), with additional variance predicted by physical function (beta=-.13; P=.07). The effect of patient and burn injury variables on depressive symptoms was mediated by body image dissatisfaction and physical function.The high prevalence of significant symptoms of depression in burn reconstruction patients and their relationship with body image suggest the importance of the routine psychological screening of patients seeking reconstruction services.
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40 Wright Street Wing Emergency Services Palmer, MA 01069
Wing Memorial Hospital 40 Wright Street
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40 Wright Street Wing Memorial Hospital Griswold Center
40 Wright St Wing Memorial Hospital