Description and Evaluation of a Multilevel Intervention for Improving HPV Vaccination Rates in a Rural South Dakota Clinic.

BACKGROUND: This study describes an education-based, multilevel intervention and its impact on human papilloma virus (HPV) vaccination rates in a rural South Dakota clinic. METHODS: At a clinic-level, nurses and clinicians were provided education on HPV vaccination guidelines and opt-out communication techniques. At a community-level, parents/guardians attended an educational session at the local middle school orientation. Surveys assessed subjective and objective knowledge pre- and post-intervention. Electronic medical records were used to examine HPV immunization rates for adolescents (aged 9-13 years), 2016-2020. These figures were compared to the number of vaccinations given across the healthcare system footprint. RESULTS: 72.7 percent of nurses and providers in the clinic utilize opt-out communication when discussing vaccinations. Increases in self-reported and objective knowledge among participants were noted. EMR review revealed the percent of adolescents vaccinated for HPV increased post-intervention. CONCLUSION: Implementation of multiple community interventions correlated with increases in community knowledge and HPV immunization in adolescents in the service area.

Tracheal Transection-A Novel Airway Management.

Background Traumatic injury of the trachea is rare, especially complete transection. Its operative revision requires an interdisciplinary approach. Case Description We hereby present a rare case of complete transection of the trachea by accident. To stabilize the patient and to allow for safe surgery, veno-venous extracorporeal support was initiated via the subclavian artery and the femoral vein. The patient was subsequently operated, and the trachea re-anastomosed with favorable outcome. Conclusion This rare case of an accidental transection of the trachea shows the importance of a good emergency rescue chain and the ability to facilitate interdisciplinary approaches in tertiary hospitals.

Impact of Elevation of Temporal Lobe During Middle Fossa Acoustic Neuroma Surgery on Contralateral Speech Discrimination.

AIM: For middle fossa acoustic neuroma approach, retractors are needed to elevate the temporal lobe to be able to access the internal auditory meatus. The temporal lobe hosts the primary and secondary auditory fields. The question arises regarding whether this elevation affects the functionality of the auditory cortex. MATERIAL AND METHODS: In patients, who underwent acoustic neuroma surgery, contralateral speech discrimination was tested pre- and postsurgery using different speech discrimination tests. Results of patients with a middle fossa approach were compared with patients with a translabyrinthine approach. RESULTS: No major differences between the translabyrinthine and the middle fossa approach could be detected. CONCLUSION: Elevation of the temporal lobe during middle fossa approach for acoustic neuroma surgery does not lead to short-term impaired contralateral speech discrimination compared with translabyrinthine approach.

An experimental evaluation of loads occurring during guided drilling for cochlear implantation.

PURPOSE: During guided drilling for minimally invasive cochlear implantation and related applications, typically forces and torques act on the employed tool guides, which result from both the surgeon's interaction and the bone drilling process. Such loads propagate through the rigid mechanisms and result in deformations of compliant parts, which in turn affect the achievable accuracy. In this paper, the order of magnitude as well as the factors influencing such loads are studied experimentally to facilitate design and optimization of future drill guide prototypes. METHODS: The experimental setup to evaluate the occurring loads comprises two six degree of freedom force/torque sensors: one mounted between a manually operated, linearly guided drill handpiece and one below the specimens into which the drilling is carried out. This setup is used to analyze the influences of drilling tool geometry, spindle speed as well as experience of the operator on the resulting loads. RESULTS: The results reveal that using a spiral drill results in lower process loads compared with a surgical Lindemann mill. Moreover, in this study, an experienced surgeon applied lower interaction forces compared with untrained volunteers. The measured values further indicate that both the intraoperative handling of the bone-attached drill guide as well as the tool removal after completing the hole can be expected to cause temporary load peaks which exceed the values acquired during the drilling procedure itself. CONCLUSIONS: The results obtained using the proposed experimental setup serve as realistic design criteria with respect to the development of future drill guide prototypes. Furthermore, the given values can be used to parameterize simulations for profound stiffness analyses of existing mechanisms.