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Context This review was undertaken to provide information concerning the advancement of research in the area of COVID-19 screening and testing during the worldwide pandemic from December 2019 through April 2023. In this review, we have examined the safety, effectiveness, and practicality of utilizing trained scent dogs in clinical and public situations for COVID-19 screening. Specifically, results of 29 trained scent dog screening peer-reviewed studies were compared with results of real-time reverse-transcription polymerase chain reaction (RT-PCR) and rapid antigen (RAG) COVID-19 testing methods. Objectives The review aims to systematically evaluate the strengths and weaknesses of utilizing trained scent dogs in COVID-19 screening. Methods At the time of submission of our earlier review paper in August 2021, we found only four peer-reviewed COVID-19 scent dog papers: three clinical research studies and one preprint perspective paper. In March and April 2023, the first author conducted new literature searches of the MEDLINE/PubMed, Google Scholar, and Cochrane Library websites. Again, the keyword phrases utilized for the searches included “COVID detection dogs,” “COVID scent dogs,” and “COVID sniffer dogs.” The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 Checklist was followed to ensure that our review adhered to evidence-based guidelines for reporting. Utilizing the results of the reviewed papers, we compiled statistics to intercompare and summarize basic information concerning the scent dogs and their training, the populations of the study participants, the types of sampling methods, the comparative tests utilized, and the effectiveness of the scent dog screening. Results A total of 8,043 references were identified through our literature search. After removal of duplicates, there were 7,843 references that were screened. Of these, 100 were considered for full-text eligibility, 43 were included for qualitative synthesis, and 29 were utilized for quantitative analysis. The most relevant peer-reviewed COVID-19 scent dog references were identified and categorized. Utilizing all of the scent dog results provided for this review, we found that 92.3 % of the studies reached sensitivities exceeding 80 and 32.0 % of the studies exceeding specificities of 97 %. However, 84.0 % of the studies reported specificities above 90 %. Highlights demonstrating the effectiveness of the scent dogs include: (1) samples of breath, saliva, trachea-bronchial secretions and urine as well as face masks and articles of clothing can be utilized; (2) trained COVID-19 scent dogs can detect presymptomatic and asymptomatic patients; (3) scent dogs can detect new SARS-CoV-2 variants and Long COVID-19; and (4) scent dogs can differentiate SARS-CoV-2 infections from infections with other novel respiratory viruses. Conclusions The effectiveness of the trained scent dog method is comparable to or in some cases superior to the real-time RT-PCR test and the RAG test. Trained scent dogs can be effectively utilized to provide quick (seconds to minutes), nonintrusive, and accurate results in public settings and thus reduce the spread of the COVID-19 virus or other viruses. Finally, scent dog research as described in this paper can serve to increase the medical community’s and public’s knowledge and acceptance of medical scent dogs as major contributors to global efforts to fight diseases.

Context As the number of medical school graduates continues to outpace the available residency training positions, applying for residency in the United States has become a highly competitive process, often associated with a low rate of selection and invitation for interview. The National Resident Matching Program (NRMP) Program Director survey provides data assessing factors considered by Program Directors (PD) in selecting and inviting candidates for interview. Assessing the evolution of these factors over time is efficacious to inform and guide prospective applicants toward improving preparation for residency application. Objectives We aim to synthesize NRMP data showing factors that PDs reported and rated as important in their decision to select and invite applicants for interview. Methods Data from residency PD surveys from 2008 to 2021 were accessed, but after applying inclusion/exclusion criteria, only the data from 2016 to 2020 were reviewed and analyzed. The NRMP survey reports provided two metrics that characterized PDs’ evaluation of the residency factors for interview, namely, “percent citing factor” and “average rating” on a 0 to 5 Likert-type scale. These two metrics were combined into an aggregate measure of importance (AI), and another measure of relative importance (RI) was constructed from normalizing the AI of each individual factor to the sum of the AI within each survey year. Results The top ranked factors were United States Medical Licensing Examination (USMLE) Step 1/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1, Letter of Recommendation (LOR) in the specialty, Medical Student Performance Evaluation (MSPE/Dean’s Letter), and USMLE Step 2 Clinical Knowledge (CK)/COMLEX Level 2 Cognitive Exam (CE) score, any failed attempt in USMLE/COMLEX, and perceived commitment to specialty. Factors rising in importance were Audition Elective/Rotation Within Your Department, Personal Statement (PS), Perceived Commitment to Specialty, Perceived Interest in Program, LOR in the Specialty, Other Life Experience, and Personal Prior Knowledge of the Applicant. Factors with declining importance were Interest in Academic Career, Awards or Special Honors in Basic Sciences, Graduate of Highly Regarded US Medical School, Awards or Special Honors in Clinical Clerkships, Lack of Gaps in Medical Education, Awards or Special Honors in Clerkship in Desired Specialty, and Consistency of Grades. Compared to the 2021 PD survey, our findings show continued predictive consistency, particularly related to specialty and program commitment. Conclusions The factors identified for the selection of medical school graduates for interview into a residency program reveal that PDs move toward a more integrated approach. Specifically, PDs are placing increasing emphasis on factors that border on subjective qualities more so than the more traditional, quantitative, and objective metrics. Medical students and educators need to continually apprise themselves of the NRMP data to inform students’ preparation endeavors throughout medical school to strengthen their application portfolios and enhance their competitiveness for the matching process.

Context Medical students with no previous experience may find it difficult to identify and palpate bony landmarks while learning physical examination skills. In a study of 168 medical schools, 72.6 % have indicated that they are utilizing ultrasound in their curriculum. Although the integration of ultrasound curriculum has become more widespread, the depth of instruction is inconsistent. Ultrasound is not commonly taught in conjunction with palpation of bony landmarks in osteopathic structural examination. Objectives The objective of this analysis was to identify whether utilizing ultrasound assistance in teaching palpation of specific thoracic vertebral bony landmarks would improve palpation accuracy in first-year medical students with no previous palpatory experience. Methods First-year medical students were given video instructions to palpate and identify a thoracic vertebral transverse process and to mark it with invisible ink. The participants were then taught and instructed to utilize ultrasound to identify the same landmark and mark it with a different color. The accuracy of palpation was measured with digital calipers. Results A test of the overall hypothesis that participants will show improved accuracy utilizing ultrasound compared with hand palpation was not significant (F=0.76, p>0.05). When separating students into groups according to patient body mass index (BMI), however, there was a trend toward significance (F=2.90, p=0.071) for an interaction effect between patient BMI and the repeated measures variable of palpation/ultrasound. When looking specifically at only those participants working with a normal BMI patient, there was a significant improvement in their accuracy with the use of ultrasound (F=7.92, p=0.017). Conclusions The analysis found increased accuracy in bony landmark identification in untrained palpators utilizing ultrasound vs. palpation alone in a normal BMI model, but not in obese or overweight BMI models. This study shows promise to the value that ultrasound may have in medical education, especially with respect to early palpation training and landmark identification.

Context Club sports are intercollegiate athletics that are student-led and not university-funded, many of which are without professional credentialing. Collegiate club athletes have an increased rate of injury compared to their NCAA counterparts. Education and implementation of stretching and strength training have demonstrated decreased rates of noncontact injuries. Objectives Educational intervention was given to club collegiate athletes to determine its effect on injury rates, perceived pain, and compliance toward injury-prevention practices. Methods Intramural collegiate athletes were educated on injury prevention that focused on targeted stretching. Surveys designed to assess the impact of the education were distributed to three men’s club lacrosse teams in Utah at the beginning and end of the season. The questions measured pain and time missed due to noncontact injury. Results Two-tailed unpaired t tests demonstrated p values <0.05 for: overall decreased levels of pain (p<0.0001); increased range of motion (ROM, p<0.0001); increased frequency of stretching the muscle groups psoas (p<0.0001), calves (p=0.0081), and piriformis (p<0.0001); decreased pain levels for the hamstring (p=0.0274); and increased frequency of stretching after practice (p<0.0001). Conclusions The increased frequency of stretching suggests increased compliance toward injury prevention practices. Decreased self-reported levels of overall pain, and decreased pain in the hamstring, show that the subjects surveyed in the sample reported less pain and increased time stretching at the end of the season compared with the beginning of the season. Educational intervention offers an affordable measure to provide club collegiate athletes with resources to reduce injury rates through athlete compliance to targeted stretches.

When a patient presents with head, neck, or respiratory concerns, the scalene muscles are not commonly considered. However, somatic dysfunctions of the anterior/middle scalenes (AMS) can be contributing to or causing these medical concerns. Although tender points within the scalene muscles have been documented within the muscle belly, they have not been documented at the insertion site. This article details how to diagnose and treat an AMS tender point with an efficient technique that requires minimal exertion and maximal comfort for both the physician and patient at a new tender point location. This article also discusses the importance of this tender point and provides a list of additional somatic dysfunctions that may be used to problem-solve a scalene tender point that fails to correct.

Context Medical professionals commonly fail to follow best practice guidelines. Drift, or a return to previous tendencies, is abundant in healthcare even when guidelines are followed initially. This “drift” was found internally at Temple University Hospital with preoperative electrocardiograms (ECGs). Best-practice guidelines were instituted and followed as a first step, but sustaining performance improvement was the ultimate goal. Objectives The objectives are to improve and maintain adherence to published guidelines for preoperative ECG testing at Temple University Hospital in a physician-led, nurse practitioner (NP)–staffed preadmission testing (PAT) clinic. Methods To start this quality improvement (QI) project, a retrospective chart review was completed to determine the number of ECGs performed in PAT at Temple University Hospital in 2017. New guidelines for ordering preoperative ECGs were then implemented, and Plan-Do-Study-Act (PDSA) cycles were performed over 3 years. A repeat retrospective chart review was completed and looked at ECGs ordered from 2018 through 2020. The number of ECGs completed in PAT before and after implementation of the new guidelines was then compared. In addition, the complexity of our surgical patients was estimated by looking at the yearly average American Society of Anesthesiology Physical Health Status (American Society of Anesthesiology [ASA] status) values assigned. Finally, the cost of performing each ECG was calculated, and the cost savings to the hospital over 4 years was determined. Results The baseline ECG rate for PAT in 2017, 2018, 2019, and 2020 at Temple University Hospital was 54.0 , 20.7, 22.3, and 21.9 %, respectively, which was a statistically significant decrease in ECG performance rate in the years after implementation of the PDSA project. The ASA status average remained constant, demonstrating that while patients’ medical diagnoses remained on average the same, reinforced training had been effective in preventing a return to previous liberal ordering tendencies. Over the course of 4 years, the reduction in unnecessary ECGs led to an estimated direct cost savings of $213,000. Conclusions Self-adoption of best-practice guidelines among clinicians is often poor; however, the barriers to adoption can be overcome with education and individual feedback. Sustaining performance improvement gains is challenging, but possible, as shown by example in one urban, academic teaching hospital’s physician-led, NP–staffed outpatient clinic.