Introduction: During the COVID-19 pandemic, medical schools needed to redirect students to alternative educational opportunities. The University of Nevada, Reno School of Medicine addressed this issue by forming a partnership with rural counties in northern Nevada to create a multicounty COVID-19 hotline clinical experience. Medical students staffed the hotline and assisted the underserved rural populations of northern Nevada by providing counseling and education via telehealth. With the support of preceptors, students completed screening forms with patients, utilized audio-only physical exam skills and clinical decision making to triage potential patients to the appropriate level of care. Methods: We utilized retrospective pre- and postassessments to assess medical students' comfort level with several hotline tasks before and after their experience as a hotline volunteer. Results: Results indicate significant improvements after hotline training and experience in students’ comfort level with answering questions about SARS-CoV-2 (P=.006); screening patients for SARS-CoV-2 (P=.0446); assessing exam findings using audio only format (P=.0429); triaging patients (P=.0103); and addressing financial access to care barriers (P=.0127). Conclusion: Participation in the multicounty COVID-19 hotline improved students’ comfort levels in all areas, with significant improvement in answering questions about SARS-CoV-2, conducting audio-only exams, screening and triaging patients, and addressing financial barriers to care. Participation allowed students to further hone their clinical skills during a pandemic. This experience can serve as a model for similar projects for other academic institutions to train their medical students while providing outreach, particularly to underserved populations such as rural communities.

BackgroundComplex ventral incisional hernia repair represents a challenging clinical condition in which biologically derived graft reinforcement is often utilized, but little long-term data inform that decision. Urinary bladder matrix (UBM) has shown effectiveness in diverse clinical settings as durable reinforcement graft material, but it has not been studied over a long term in ventral incisional hernia repair. This study evaluates the clinical, radiographic, and histological outcome of complex incisional hernia repair using UBM reinforcement with 12–70 months of follow-up.MethodsA single-arm, retrospective observational study of all ventral incisional hernia repairs utilizing UBM reinforcement over a 6-year time frame by a single surgeon was performed. Patients were assessed in long-term follow-up clinically and with the Carolina Comfort Scale. A subset of patients was assessed with abdominal wall ultrasound or CT scan. Three patients had abdominal wall fascial biopsies years after the incisional hernia repair with UBM graft, and the histology is analyzed.Results64 patients underwent repair of complex incisional hernias with UBM graft reinforcement by a single surgeon. 42 patients had concomitant procedures including large or small bowel resection, excision of infected mesh, evacuation of abscess or hematoma, cholecystectomy, or panniculectomy with abdominoplasty. 16 patients had ostomies at the time of repair. Median follow-up time is 36 months, with a range of 12–70 months. Nine patients (14%) have required surgical repair of a recurrent hernia, and a tenth patient has a recurrence that is managed non-surgically, for a total recurrence rate of 15.6% over the entire time frame. Median time to recurrence was 32 months, and a Kaplan–Meier freedom from recurrence curve is depicted. 28 patients have undergone ultrasound or CT assessments of the abdominal wall which demonstrate radiographic fascial integrity 12–70 months after repair. Three patients have been re-explored for unrelated reasons in the years following ventral incisional hernia repair with UBM, and full thickness fascial biopsies demonstrate a robust remodeling response histologically similar to native myofascial tissue. No patients have developed graft infection, fistulization to the graft, or required graft explantation. Carolina Comfort Scale assessment of 45 patients 3 years after the repair averaged 16 out of a possible 115.ConclusionIn 64 patients undergoing complex ventral incisional hernia repair with UBM reinforcement, all have experienced successful resolution of complex clinical conditions and 15.6% of these repairs have recurred at a median follow-up of 3 years. Three full-thickness biopsies of the repaired fascia years later shed light on a promising remodeling response which may signal strength and durability comparable to native fascia.

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Background: Intracranial schwannomas are most commonly associated with the vestibulocochlearnerve, often leading to hearing loss, tinnitus, and vestibular dysfunction. Much less often, a schwannomacan arise from the trigeminal nerve which can lead to facial pain, numbness, and weakness.<br />Purpose: We explored a case of a patient with an magnetic resonance imaging (MRI)-confirmed trigeminalschwannoma that was mistaken for a vestibulocochlear schwannoma because of a myriad of ipsilateralvestibulocochlear symptoms.<br />Research Design: This is a retrospective chart review and case study, with no statistics applied.<br />Results: This diagnostic error led to clinical confusion and inaccurate medical record-keeping. Radiologistsand radiation oncologists deemed the patient’s symptoms to be unrelated to the asymptomatictrigeminal schwannoma, and she was referred to an otolaryngologist following complaints of ear fullness,ear pain, and hearing loss. The patient’s audiogram showed ipsilateral, asymmetric sensorineural hearingloss, and she was diagnosed with concurrent Meniere’s disease. Alternative explanations, such as anadditional schwannoma or external compression of the vestibulocochlear nerve, were considered, but notapparent on MRI.<br />Conclusions: From this case, we see that symptoms do not always concur with imaging results and thatmultiple etiologies, especially when one is rare, can confuse a clinical picture.<br />