***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Endobronchial ultrasound-guided transbronchial needle aspiration ( EBUS-TBNA ) is very operator dependent and has a long learning curve . Simulation-based training might shorten the learning curve , and an assessment tool with solid validity evidence could ensure basic competency before unsupervised performance . A total of 16 respiratory physicians , without EBUS experience , were r and omised to either virtual-reality simulator training or traditional apprenticeship training on patients , and then each physician performed EBUS-TBNA procedures on three patients . Three blinded , independent assessor assessed the video recordings of the procedures using a newly developed EBUS assessment tool ( EBUSAT ) . The internal consistency was high ( Cronbach 's α=0.95 ) ; the generalisability coefficient was good ( 0.86 ) , and the tool had discriminatory ability ( p<0.001 ) . Procedures performed by simulator-trained novices were rated higher than procedures performed by apprenticeship-trained novices : mean±sd are 24.2±7.9 points and 20.2±9.4 points , respectively ; p=0.006 . A pass/fail st and ard of 28.9 points was established using the contrasting groups method , result ing in 16 ( 67 % ) and 20 ( 83 % ) procedures performed by simulator-trained novices and apprenticeship-trained novices failing the test , respectively ; p<0.001 . The endobronchial ultrasound assessment tool could be used to provide reliable and valid assessment of competence in EBUS-TBNA , and act as an aid in certification . Virtual-reality simulator training was shown to be more effective than traditional apprenticeship training . Virtual-reality simulation-based training shortens the learning curve for endobronchial ultrasound ( EBUS ) OBJECTIVE The differential diagnosis of sarcoidosis and tuberculosis is difficult , especially in countries with a high tuberculosis burden . We hypothesized that sonographic features on endobronchial ultrasonography ( EBUS ) would help in differentiating tuberculosis from sarcoidosis . In this study , the endosonographic features of tuberculosis and sarcoidosis are compared . METHODS This was a retrospective analysis of prospect ively collected data of patients with intrathoracic lymphadenopathy who underwent EBUS-guided transbronchial needle aspiration ( TBNA ) , and were finally diagnosed with sarcoidosis or tuberculosis .  Sonographic features such as size , shape ( round or oval ) , margin ( distinct or indistinct ) , echogenicity ( heterogeneous or homogeneous ) , presence or absence of a central hilar structure , and coagulation necrosis sign were recorded and compared in the 2 groups . RESULTS During the study period , 249 EBUS-guided TBNA procedures were performed and a diagnosis of sarcoidosis ( n = 118 ) or tuberculosis ( n = 47 ) was made in 165 patients . A total of 358 lymph node stations were examined . Heterogeneous echotexture ( 53.4 % vs 12.6 % , P < .001 ) and coagulation necrosis ( 26.1 % vs 3.3 % ; P < .001 ) were significantly higher in tuberculous lymph nodes . A combination of a positive tuberculin skin test ( TST ) and either heterogeneous echotexture or coagulation necrosis sign had specificity of 98 % and positive predictive value of 91 % for a diagnosis of tuberculosis . CONCLUSIONS Sonographic features of heterogeneous echotexture or coagulation necrosis in the lymph nodes on EBUS are fairly specific for tuberculosis . Along with a positive TST , these features strongly favor a diagnosis of tuberculosis over sarcoidosis BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration ( EBUS-TBNA ) is superior to conventional transbronchial needle aspiration ( cTBNA ) in the staging of lung cancer . However , its efficiency in diagnosis of sarcoidosis when combined with endobronchial biopsy ( EBB ) and transbronchial lung biopsy ( TBLB ) has not been studied . This r and omized controlled trial compares diagnostic yield of EBUS-TBNA vs cTBNA in combination with EBB and TBLB . METHODS Patients with clinical diagnosis of sarcoidosis were r and omized 1:1 to EBUS-TBNA or cTBNA . All patients underwent TBLB and EBB . The primary outcome was detection of granulomas . The secondary end points were the individual and cumulative yields of various procedures , serious adverse events , and procedure time . RESULTS Of the 130 patients , sarcoidosis was diagnosed in 117 ( 62 cTBNA , 55 EBUS-TBNA ) . The two groups were similar at baseline . Granulomas were demonstrated in 104 ( 53 cTBNA , 51 EBUS-TBNA ) patients and were similar in two groups ( 85.5 % vs 92.7 % , P = .34 ) . Individually , EBUS-TBNA had the highest yield ( 41 of 55 , 74.5 % ) , which was better than cTBNA ( 30 of 62 , 48.4 % , P = .004 ) or EBB ( 40 of 111 , 36.3 % , P < .0001 ) but not TBLB ( 78 of 112 , 69.6 % , P = .54 ) . Adding EBB/TBLB to cTBNA led to an increase in granuloma detection , whereas the addition of TBLB ( but not EBB ) significantly enhanced the yield of EBUS-TBNA . The procedure time was significantly longer with EBUS-TBNA . No major adverse events occurred . CONCLUSIONS Individually , EBUS-TBNA has the highest diagnostic yield in sarcoidosis , but it should be combined with TBLB for the optimal yield . The diagnostic yield of cTBNA ( plus EBB and TBLB ) is similar to EBUS-TBNA plus TBLB . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT01908868 ; URL : www . clinical trials.gov BACKGROUND AND OBJECTIVE Endobronchial ultrasound with transbronchial needle aspiration ( EBUS-TBNA ) is a pulmonary procedure that can be challenging to learn . This study aims to compare trainee EBUS-TBNA performance during clinical procedures , following training with a computer EBUS-TBNA simulator versus conventional clinical EBUS-TBNA training . METHODS A prospect i ve study of pulmonary trainees performing EBUS-TBNA procedures on patients with suspected lung cancer and mediastinal adenopathy . Two cohorts of trainees were each evaluated while performing EBUS-TBNA on two patients . Group 1 received training by performing 15 cases on an EBUS-TBNA simulator ( n = 4 ) and had never performed a clinical EBUS-TBNA procedure . Group 2 received training by doing 15 - 25 EBUS-TBNA procedures on patients ( n = 4 ) . RESULTS There was no significant difference in the primary outcome measure of total EBUS-TBNA procedure time/number of successful aspirates between Groups 1 and 2 ( 3.95 ( ±0.93 ) vs 3.64 ( ±0.89 ) , P = 0.51 ) . Total learner EBUS-TBNA procedure time in minutes ( 23.67 ( ±5.58 ) vs 21.81 ( ±5.36 ) , P = 0.17 ) and percentage of successful aspirates ( 93.3 % ( ±5.8 % ) vs 86.3 % ( ±6.7 % ) , P = 0.12 ) were not significantly different between Group 1 and Group 2 . The only significant difference found between Group 1 and Group 2 was time to intubation in minutes ( 0.99 ( ±0.46 ) vs 0.50 ( ±0.42 ) , P = 0.04 ) . CONCLUSIONS EBUS-TBNA simulator use leads to rapid acquisition of clinical EBUS-TBNA skills comparable with that obtained with conventional training methods using practice on patients , suggesting that skills learned using an EBUS-TBNA simulator are transferable to clinical EBUS-TBNA performance . EBUS-TBNA simulators show promise for training , potentially minimizing the burden of procedural learning on patients BACKGROUND Linear endobronchial ultrasound with transbronchial needle aspiration ( EBUS-TBNA ) is a revolutionary bronchoscopic procedure that is challenging to learn . OBJECTIVES To compare two methods used to teach EBUS-TBNA : wet laboratory ( lab ) versus computer EBUS-TBNA simulation . METHODS A prospect i ve , r and omized study of respirologists , thoracic surgeons and trainees learning EBUS-TBNA at a two-day continuing medical education course . All subjects received education via a series of lectures and live cases , followed by r and omization to learn EBUS-TBNA predominantly either by wet lab simulation ( n=6 ) or computer simulation ( n=6 ) . All subjects then completed testing of their EBUS-TBNA skills via a previously vali date d method using simulated cases on EBUS-TBNA simulators and question naires evaluating learner preferences . RESULTS There were no significant differences between the computer EBUS-TBNA simulator group and the wet lab group in procedure time ( 25.3±6.1 min versus 25.2±2.5 min ; P=0.984 ) and percentage of successful biopsies ( 81.3±14.9 % versus 74.0±17.3 % ; P=0.453 ) . The computer simulator group performed significantly better than the wet lab group in the percentage of lymph nodes correctly identified ( 70.4±16.7 % versus 42.9±19.9 % ; P=0.002 ) . Wet lab simulation was associated with increased learner confidence with operating the real EBUS-TBNA bronchoscope . All subjects responded that wet lab and computer EBUS-TBNA simulation offered important complementary learning opportunities . CONCLUSION Computer EBUS-TBNA simulation and wet lab simulation are effective methods of learning basic EBUS-TBNA skills and appeared to be complementary BACKGROUND Performance of linear probe endobronchial ultrasound-guided transbronchial needle aspiration ( EBUS-TBNA ) for staging non-small-cell lung cancer has been extensively studied . Alternate indications for its use are less well characterised , and performance in other clinical setting s may differ . METHODS We examined a prospect ively collected cohort comprising the first 215 patients undergoing EBUS-TBNA at our institution . Patients were analysed according to the clinical and radiological indication for referral . We also examined the effect of the procedural learning curve on diagnostic sensitivity . RESULTS A total of 215 patients underwent 216 EBUS-TBNA procedures . EBUS-TBNA returned adequate tissue for cytopathological analysis in 202 of 216 procedures ( 94 % ) . Overall sensitivity for detection of malignancy was 0.92 ( 95 % confidence interval 0.86 - 0.96 ) ; however , this varied according to the primary indication for EBUS-TBNA . Diagnostic sensitivity was high among all sub-groups , but the negative predictive value varied depending on the clinical indication for the procedure . We estimate 104 invasive surgical procedures and 32 inpatient admissions were avoided by use of EBUS-TBNA . Significant improvement in diagnostic performance was seen after 20 procedures were completed , and diagnostic accuracy did not peak until after 50 procedures . CONCLUSIONS EBUS-TBNA is able to confirm accurately histologically a large number of disease processes , both malignant and benign , in all clinical indications studied . The procedure is safe even when carried out by proceduralists with minimal prior experience . Diagnostic performance continues to improve beyond 50 cases carried out BACKGROUND AND OBJECTIVE Endobronchial ultrasound is a revolutionary diagnostic pulmonary procedure . The use of a computer endobronchial ultrasound simulator could improve trainee procedural skills before attempting to perform procedures on patients . This study aims to compare endobronchial ultrasound performance following training with simulation versus conventional training using patients . METHODS A prospect i ve study of pulmonary medicine and thoracic surgery trainees . Two cohorts of trainees were evaluated using simulated cases with performance metrics measured by the simulator .  Group 1 received endobronchial ultrasound training by performing 15 cases on an endobronchial ultrasound simulator ( n=4 ) . Group 2 received endobronchial ultrasound training by doing 15 - 25 cases on patients ( n=9 ) . RESULTS Total procedure time was significantly shorter in group 1 than group 2 ( 15.15 ( ±1.34 ) vs 20.00 ( ±3.25 ) min , P<0.05 ) . The percentage of lymph nodes successfully identified was significantly better in group 1 than group 2 ( 89.8 ( ±5.4 ) vs 68.1 ( ±5.2 ) , P < 0.05 ) . There was no difference between group 1 and group 2 in the percentage of successful biopsies ( 100.0 ( ±0.0 ) vs 90.4 ( ±11.5 ) , P=0.13 ) . The learning curves for simulation trained fellows did not show an obvious plateau after 19 simulated cases . CONCLUSIONS Using an endobronchial ultrasound simulator leads to more rapid acquisition of skill in endobronchial ultrasound  
    Output:
    
Importantly , skills acquired on a simulator could be transferred to real-world patients .
We conclude that an EBUS simulator  or EBUS assessment tools  can objective ly assess the training of an EBUS trainee .
Simulator-based training is a useful modality in EBUS training .