Evaluation of the Safety of Uninterrupted Warfarin Anticoagulation With Tranexamic Acid in Total Joint Arthroplasty.

Background: The continuation of long-term warfarin therapy is gaining acceptance in minor surgeries but maintaining therapeutic international normalized ratio (INR) values among patients during major orthopedic procedures raises concern. While bridging therapy with low-molecular-weight heparin is currently recommended for patients receiving anticoagulation, few studies have evaluated the safety of continuing warfarin during total joint arthroplasty. This study evaluated the safety and efficacy of continuous warfarin anticoagulation through total joint arthroplasty with and without prophylactic tranexamic acid (TXA).

The Joint Awareness Score: A Shortened, Simplified, Improved Alternative to the Forgotten Joint Score.

Background: The Forgotten Joint Score (FJS) is a 12-question patient-reported outcomes measure created to measure a patient's awareness of their artificial joint. The FJS has attained wide usage, though it is not without weaknesses. Our patients report that the semantics of the English translation are flawed and that the 5 answer options for each question are poorly differentiated.

Standardized Follow-Up Recommendations Improve Reporting of Incidental Renal Lesions in a Community Setting.

Introduction The objective of this quality improvement study was to assess radiology report follow-up recommendation trends upon detection of incidental renal lesions before and after instituting standardized follow-up macros.  Materials and methods A retrospective review was performed in 2019 of multiphase imaging workups on renal lesions (n = 396), including the following imaging modalities: ultrasound, CT with and without contrast, and spine MRI. Utilizing the same collection methods, a similar retrospective set of cases was collected in 2021, 12 months following the creation of the renal follow-up macros (n = 501).

Preparing Austere Maritime Surgical Teams for Deployment During the COVID-19 Global Pandemic: Is It Time to Change the Training Pipeline?

Introduction: Navy Medicine's Role 2 Light Maneuver (R2LM) Emergency Resuscitative Surgical Systems (ERSS) are austere surgical teams manned, trained, and equipped to provide life-saving damage control resuscitation and surgery in any environment on land or sea. Given the restrictions related to the COVID-19 pandemic, the previously established pre-deployment training pipeline for was modified to prepare a new R2LM team augmenting a Role 1 shipboard medical department.

Methods: The modified curriculum created in response to COVID-19 related restriction is compared and contrasted to the established pre-deployment R2LM ERSS curriculum.

Return on Investment Analysis of Health Experts onLine at Portsmouth: A 2-Year Review of the Navy's Newest Teleconsultation System.

Background: Health Experts onLine at Portsmouth (HELP) is a web-based teleconsultation system launched in June 2014 to facilitate communication between specialists at Naval Medical Center Portsmouth and providers assigned to both the fleet forces and primary care clinics across the eastern United States, Europe, and the Middle East. Specialist consultations through the HELP system purport to improve access to care for patients who otherwise might be referred to the civilian network or medically evacuated (MEDEVACed) to Naval Medical Center Portsmouth for specialized care. If HELP-facilitated communications help avoid civilian referrals or MEDEVACs, the associated costs of that care should be reduced.

Expanding the indications for laparoscopic retroperitoneal adrenalectomy: experience with 81 resections.

Background: Laparoscopic retroperitoneal (RP) adrenalectomy has gained popularity as the preferred approach over transabdominal (TA) method; however, surgeons have been reluctant to offer this operation to obese patients because of the concerns over inadequate working space and overall perceived higher rate of complications. The aim of the present study was to evaluate the feasibility and safety of RP adrenalectomy compared with TA adrenalectomy, specifically in morbidly obese patients.

Methods: All laparoscopic adrenalectomies performed at our institution between 2004 and 2012 were reviewed retrospectively.

Myasthenia gravis--an unexpected cause of respiratory failure and reversible left ventricular dysfunction after cardiac surgery.

We report a case of postpericardiotomy myasthenia gravis. A 68-year-old male patient without prior history of neuromuscular or autoimmune disorders presented with respiratory failure and severe left ventricular dysfunction four weeks after mitral valve replacement. Markedly elevated acetylcholine receptor antibodies were noted, and the patient responded promptly to immunologic therapy.