Melrose-Wakefield Hospital

About: Melrose-Wakefield Hospital is a healthcare organization based out in Melrose, Massachusetts, United States. It is known for research contribution in the topics: Antimicrobial stewardship & Breastfeeding. The organization has 35 authors who have published 39 publications receiving 1017 citations.

A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards.

Abstract: OBJECTIVES: Deteriorating ward patients are at increased risk. Electronic automated advisory vital signs monitors may help identify such patients and improve their outcomes. SETTING: A total of 349 beds, in 12 general wards in ten hospitals in the United States, Europe, and Australia. PATIENTS: Cohort of 18,305 patients. DESIGN: Before-and-after controlled trial. INTERVENTION: We deployed electronic automated advisory vital signs monitors to assist in the acquisition of vital signs and calculation of early warning scores. We assessed their effect on frequency, type, and treatment of rapid response team calls; survival to hospital discharge or to 90 days for rapid response team call patients; overall type and number of serious adverse events and length of hospital stay. MEASUREMENTS AND MAIN RESULTS: We studied 9,617 patients before (control) and 8,688 after (intervention) deployment of electronic automated advisory vital signs monitors. Among rapid response team call patients, intervention was associated with an increased proportion of calls secondary to abnormal respiratory vital signs (from 21% to 31%; difference [95% confidence interval] 9.9 [0.1-18.5]; p = .029). Survival immediately after rapid response team treatment and survival to hospital discharge or 90 days increased from 86% to 92% (difference [95% confidence interval] 6.3 [0.0-12.6]; p = .04). Intervention was also associated with a decrease in median length of hospital stay in all patients (unadjusted p < .0001; adjusted p = .09) and more so in U.S. patients (from 3.4 to 3.0 days; unadjusted p < .0001; adjusted ratio [95% confidence interval] 1.03 [1.00-1.06]; p = .026). The time required to complete and record a set of vital signs decreased from 4.1 ± 1.3 mins to 2.5 ± 0.5 mins (difference [95% confidence interval] 1.6 [1.4-1.8]; p < .0001). CONCLUSIONS: Deployment of electronic automated advisory vital signs monitors was associated with an improvement in the proportion of rapid response team-calls triggered by respiratory criteria, increased survival of patients receiving rapid response team calls, and decreased time required for vital signs measurement and recording (NCT01197326).

The Critical Role of the Staff Nurse in Antimicrobial Stewardship—Unrecognized, but Already There

Abstract: An essential participant in antimicrobial stewardship who has been unrecognized and underutilized is the "staff nurse." Although the role of staff nurses has not formally been recognized in guidelines for implementing and operating antimicrobial stewardship programs (ASPs) or defined in the medical literature, they have always performed numerous functions that are integral to successful antimicrobial stewardship. Nurses are antibiotic first responders, central communicators, coordinators of care, as well as 24-hour monitors of patient status, safety, and response to antibiotic therapy. An operational analysis of inpatient admissions evaluates these nursing stewardship activities and analyzes the potential benefits of nurses' formal education about, and inclusion into, ASPs.

Comparison of SMAS plication with SMAS imbrication in face lifting

Abstract: Undermining and imbricating the superficial musculoaponeurotic system (SMAS) have been advocated by many recent authors to enhance the results of face lifting procedures. Because all undermining has dangers, we compared in 5 fresh cadavers and 15 patients the immediate operative effects on the labial commissures, buccolabial grooves, submental areas, and cervicomental regions of undermining and imbrication with those of plication without any undermining. Closures were made on both sides and with each technique with the layers pulled to their limit of stretch. We found no significant difference between the two methods in the effects on the areas mentioned. Disproven by this study is the theory that undermining and imbricating of the SMAS by itself will permit, at the time of surgery, greater displacement of esthetically important landmarks than will mere SMAS plication without undermining.

Pelvic hematoma after an ilioinguinal nerve block for orchialgia.

Abstract: I lioinguinal nerve block may be performed for either diagnosis of nerve entrapment in patients with chronic pelvic pain (1) or as part of regional anesthesia/analgesia when surgery of the inguinal area is contemplated. In many patients complaining of chronic orchialgia, the source of pain may be elusive, despite extensive diagnostic work-up (2). In this case, a local anesthetic block of the ilioinguinal nerve was helpful in the diagnosis of referred testicular pain. Reported herein is a case of a small, retroperitoneal pelvic hematoma after the performance of this block.