***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: OBJECTIVES High quality CPR skill retention is poor . We hypothesized that " just-in-time " and " just-in-place " training programs would be effective and well-accepted to maintain CPR skills among PICU staff . METHODS " Rolling Refreshers " , a portable manikin/defibrillator system with chest compression sensor providing automated corrective feedback to optimize CPR skills , were conducted daily in the PICU with multidisciplinary healthcare providers . Providers practice d CPR until skill success was attained , prospect ively defined as <3 corrective prompts within 30s targeting chest compression ( CC ) rate 90 - 120/min , CC depth > 38 mm during continuous CPR . Providers completing > or = 2 refreshers/month ( Frequent Refreshers [ FR ] ) were compared to providers completing < 2 refreshers/month ( Infrequent Refreshers [ IR ] ) for time to achieve CPR skill success . Univariate analysis performed using non-parametric methods . Following actual cardiac arrests , CPR providers were surveyed for subjective feedback on training approach efficacy ( 5-point Likert scale ; 1=poor to 5=excellent ) . RESULTS Over 15 weeks , 420 PICU staff were " refreshed " : 340 nurses , 34 physicians , 46 respiratory therapists . A consecutive sample of 20 PICU staff was assessed before subsequent refresher sessions ( FREQ n=10 , INFREQ n=10 ) . Time to achieve CPR skill success was significantly less in FREQ ( median 21s , IQR : 15.75 - 30s ) than in INFREQ ( median 67s , IQR : 41.5 - 84s ; p<0.001 ) . Following actual resuscitations , CPR providers ( n=9 ) rated " Rolling Refresher " training as effective ( mean=4.2 ; Likert scale 1 - 5 ; st and ard deviation 0.67 ) . CONCLUSIONS A novel " Rolling Refresher " CPR skill training approach using " just-in-time " and " just-in-place " simulation is effective and well received by PICU staff . More frequent refreshers result ed in significantly shorter times to achieve proficient CPR skills BACKGROUND Time to cardiopulmonary resuscitation ( CPR )  is a main determinant of survival after out-of-hospital cardiac arrest . Only widespread implementation of training courses for laypersons can decrease response time . METHODS AND RESULTS In this prospect i ve r and omized trial , we evaluated how laypersons retained CPR skills and skills in using the automated external defibrillator ( AED ) . A total of 1095 volunteers were r and omly assigned to receive CPR/AED-training courses  of 2h ( 375 persons ) , 4h ( 378 persons ) or 7h ( 342 persons ) duration . Courses were held in accordance with the guidelines for CPR . All trainees were tested immediately after the initial class in a st and ardized test scenario using an AED and a manikin . Either at 6 or at 12 months , retests were given to 164 and 206 volunteers , respectively . In 479 volunteers , retesting was completed at both 6- and 12-month intervals . At the immediate tests , the 7-h training group showed a slightly higher rate of correct responses ( 7h : 96 % , 4h : 94 % , 2h : 92 % ) ( p<0.001 ) . Skill retention decreased significantly in the three groups and was lowest after 12 months if no 6-month retests were done . In trainees who did undergo retesting at 6 months , skills did not deteriorate at 12 months . There were no significant differences between the three groups ( overall correct responses : 2h : 72 % , 4h : 73 % , 7h : 74 % ) ( ns ) . CONCLUSIONS A 2-h class is sufficient to acquire and retain CPR and AED skills for an extended time period provided that a brief re-evaluation is performed after 6 months OBJECTIVE A head-to-head trial was conducted to compare laypersons ' long-term retention of life-saving psychomotor and cognitive skills learned in the traditional multi-hour training format for basic cardiopulmonary resuscitation and automated external defibrillator use to those learned in an abbreviated ( 30 min ) course . METHODS Laypersons were r and omized to either : ( 1 ) the  traditional multi-hour Heartsaver-Automated External Defibrillator ( Heartsaver-AED ) group ; or ( 2 ) the 30-min course group ( cardiopulmonary resuscitation , choking , and automated external defibrillator use )  . Immediately after training , and at 6 months , participants were provided identical individual testing scenarios . In addition to audio-video recordings , computerized recordings of compression rate/depth , ventilation rates , and related pauses were obtained and subsequently rated by blinded review ers . RESULTS Performance following 30-min training was either equivalent or superior ( p<0.007 ) to the multi-hour Heartsaver-Automated External Defibrillator training in all measurements , both immediately and 6 months after training . Although retention of certain skills deteriorated over the 6 months among a significant number of participants from both groups , 84 % of the 30-min training group still was judged , overall , to perform cardiopulmonary resuscitation adequately . Moreover , 93 % still were performing chest compressions adequately and 93 % continued to apply the automated external defibrillator and deliver shocks correctly . CONCLUSIONS Using innovative learning techniques , 30-min cardiopulmonary resuscitation and automated external defibrillator training is as effective as traditional multi-hour courses , even after 6 months . Thirty-minute courses should decrease labor intensity , dem and s on re sources , and time commitments for cardiopulmonary resuscitation courses , thus facilitating more widespread and frequent retraining OBJECTIVE Multiple procedures performed in parallel may cause each procedure to be performed less effectively than if performed in isolation . BLS performed by prehospital providers potentially includes artificial ventilations , chest compressions , and application of an automated external defibrillator ( AED ) . This study examines the effectiveness of  artificial ventilation  and  chest compressions  both with and without an AED . METHODS Thirty-six prehospital providers participated in a prospect i ve observational study . Tested in pairs ( n=18 ) , subjects r and omly completed three , 6-min scenarios [ apneic patient with a pulse ( VENT ) , a pulseless patient ( CPR ) , and a pulseless patient with an AED available ( CPR+AED ) ] . A full-torso manikin capable of generating a carotid pulse was connected to a computer to record number of ventilations , tidal volume , flow rate , number of compressions , and compression depth . Data were analyzed by t-test , ANOVA , and Mann-Whitney U-test . RESULTS Artificial ventilation performed in isolation provided more correct ventilations than during CPR or CPR+AED ( 25.7 % , 14.2 % , 13.7 % , p=0.02 ) . Fewer ventilations were delivered during CPR and CPR+AED ( p=0.03 ) . More compressions were delivered with CPR alone vs. CPR+AED ( 51.9 , 35.7 min(-1 ) , p=0.00 ) . More correct compressions were delivered during CPR alone vs. CPR+AED ( p=0.05 ) . CONCLUSIONS Both the quality and quantity of BLS decreases as the number of procedures performed simultaneously increases . Further decrements might occur when ALS skills enter into resuscitation . These results suggest a need to automate and /or prompt the performance of BLS to optimize resuscitation OBJECTIVE To evaluate a new , 1-h , condensed training programme to teach continuous chest compression cardiopulmonary resuscitation ( CCC-CPR ) and automated external defibrillator ( AED ) skills to a cohort of eight grade public school students . METHODS RESULTS Thirty-three eligible subjects completed the programme ; mean age 13.7 years ; 48.5 % female . Eight participants reported some prior training in CPR and AED use . Following initial training , 29/33 ( 87.8 % ) subjects demonstrated proficiency at CCC-CPR and AED application/operation  in a mock adult cardiac arrest scenario . At four-weeks , 28/33 ( 84.8 % ) subjects demonstrated skill retention in similar scenario testing . Subjects also showed improvement in written knowledge regarding AED use as shown by scores on an AHA based written exam ( 60.9 % versus 77.3 % ; p<0.001 ) . CONCLUSION With our focused , condensed training program , eighth grade public school students became proficient in  CCC-CPR and AED use . This is the first study to document the ability of middle school students to learn and retain  CCC-CPR and AED skills for adult sudden cardiac arrest victims with such a curriculum BACKGROUND The rate of survival after out-of-hospital cardiac arrest is low . It is not known whether this rate will increase if laypersons are trained to attempt defibrillation with the use of automated external defibrillators ( AEDs ) . METHODS We conducted a prospect i ve , community-based , multicenter clinical trial in which we r and omly assigned community units ( e.g. , shopping malls and apartment complexes ) to a structured and monitored emergency-response system involving lay volunteers trained in cardiopulmonary resuscitation ( CPR ) alone or in CPR and the use of AEDs . The primary outcome was survival to hospital discharge . RESULTS More than 19,000 volunteer responders from 993 community units in 24 North American regions participated . The two study groups had similar unit and volunteer characteristics . Patients with treated out-of-hospital cardiac arrest in the two groups were similar in age ( mean , 69.8 years ) , proportion of men ( 67 percent ) , rate of cardiac arrest in a public location ( 70 percent ) , and rate of witnessed cardiac arrest ( 72 percent ) . No inappropriate shocks were delivered . There were more survivors to hospital discharge in the units assigned to have volunteers trained in CPR plus the use of AEDs ( 30 survivors among 128 arrests ) than there were in the units assigned to have volunteers trained only in CPR ( 15 among 107 ; P=0.03 ; relative risk , 2.0 ; 95 percent confidence interval , 1.07 to 3.77 ) ; there were only 2 survivors in residential complexes . Functional status at hospital discharge did not differ between the two groups . CONCLUSIONS Training and equipping volunteers to attempt early defibrillation within a structured response system can increase the number of survivors to hospital discharge after out-of-hospital cardiac arrest in public locations . Trained laypersons can use AEDs safely and effectively OBJECTIVE Our study evaluates the impact of features of automated external defibrillators ( AEDs ) on the performance and speed of untrained laypersons to deliver a shock and initiate CPR after a shock . METHODS This was a r and omized trial of volunteer laypersons without AED or advanced medical training . Subjects were assigned to use one of six different models of AEDs on a manikin in simulated cardiac arrest . No instructions on AED operation were provided . Primary endpoints were shock delivery and elapsed time from start to shock . Secondary endpoints included time to power-on , initiation of CPR , adequacy of pad placement and subjects ' ratings of ease of use ( 1=very easy , 5=very difficult ) . RESULTS Most subjects ( 109/120 ; 91 % ) were able to deliver a shock . Median time from start of scenario to shock delivery was 79 s ( IQR : 67 - 99 ) . Of the 11 participants who did not deliver shock  , eight never powered on the device . Time to power-on was shorter in devices with open lid ( median 12s , IQR 8 - 27 s ) and pull h and le ( 17s , IQR 9 - 20s ) mechanisms than with a push button ( 37s , IQR 18 - 69 s ; p=0.000 ) . Pad position on the manikin was judged adequate for 86 ( 77 % ) of the 111 subjects who placed pads . Devices which gave more detailed voice instruction for pad placement had higher rates of adequate pad position [ 38/39 ( 97 % ) versus 50/73 ( 68 % ) , p=0.001 ] . With AEDs that provided step-by-step CPR instruction , 49/58 ( 84 % ) subjects began CPR compared to 26/51 ( 51 % ) with AEDs that only prompted to start CPR ( p=0.01 ) . Participants rated all the models easy to use ( overall mean 1.48 ; individual device means 1.28 - 1.71 ) . CONCLUSIONS Most untrained laypersons were successful in delivering a shock . Device features had the most impact on these functions : ability and time to power-on device , adequacy of pad position and initiation of CPR BACKGROUND The role of e-learning in contemporary healthcare education is quickly developing . The aim of this study was to examine the relationship between the use of an e-learning simulation programme ( Microsim , Laerdal , UK ) prior to attending an Advanced Life Support ( ALS ) course and the subsequent relationship to c and i date performance . METHODS An open label , multi-centre r and omised controlled study was conducted . The control group received a course manual and pre-course MCQ four weeks prior to the face to face course . The intervention group in addition received the Microsim programme on a CD . The primary 
    Output:
    
There is good evidence to support alternative methods of AED training including lay instructors , self directed learning and brief training .
There is also evidence to support that no training is needed but even brief training can improve speed of shock delivery and electrode pad placement .