***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: INTRODUCTION Majority of studies on evaluation of emergency management courses have focused on outcomes such as knowledge and skills demonstrated in non- clinical or traditional testing manner . Such surrogate outcomes may not necessarily reflect vital changes in practice . The aim of this study was to determine if and to what extent , specific training in the management of life threatening emergencies result ed in an increased in compliance with established care guidelines of doctors working in the emergency departments of public sector hospitals in Pakistan . METHODS A cluster r and omised controlled trial was conducted in three districts hospitals in three cities ( Khairpur , Vehari and Peshawar ) of Pakistan . Thirty-six doctors , 18 in intervention ( trained in ESS-EMNCH training ) and 18 in control ( untrained ) , were enrolled and 248 life threatening emergency events , 124 in each group , were observed for the correct use of the Airway , Breathing , Circulation ( ABC ) structured approach . The outcome measure was structured approach defined a priori . Data was analysed by using STATA software . RESULTS At individual level , 79 ( 63.7 % ) life threatening episodes were managed according to the structured approach in the intervention group and 46 ( 37.1 % ) were managed according to the structured approach in controls ( OR 2.98 , 95%CI 1.78 - 4.99 , p-value=0.0001 ) . At cluster level , the mean percentage ( 95 % CI ) of the structured approach used by doctors in the intervention group [ 62.9 % ( 50.4 - 75.3 % ) ] , was significantly higher than those in the control group , [ 36.3 % ( 26.3 - 46.4 ) ] ( p-value=0.001 ) . CONCLUSIONS 5-day training of ESS-EMNCH significantly increased the compliance with established care guidelines of doctors during their management of life threatening emergency episodes in the public sector hospitals in Pakistan Objectives : To assess the effect of high-fidelity simulation ( SIM ) on cognitive performance after a training session involving several mock resuscitations design ed to teach and reinforce Pediatric Advanced Life Support ( PALS ) algorithms . Methods : Pediatric residents were r and omized to high-fidelity simulation ( SIM ) or st and ard mannequin ( MAN ) groups . Each subject completed 3 study phases : ( 1 ) mock code exercises ( asystole , tachydysrhythmia , respiratory arrest , and shock ) to assess baseline performance ( PRE phase ) , ( 2 ) a didactic session review ing PALS algorithms , and ( 3 ) repeated mock code exercises requiring identical cognitive skills in a different clinical context to assess change in performance ( POST phase ) . SIM subjects completed all 3 phases using a high-fidelity simulator ( SimBaby , Laerdal Medical , Stavanger , Norway ) , and MAN subjects used SimBaby without simulated physical findings ( ie , as a st and ard mannequin ) . Performance in PRE and POST was measured by a scoring instrument design ed to measure cognitive performance ; scores were scaled to a range of 0 to 100 points . Improvement in performance from PRE to POST phases was evaluated by mixed modeling using a r and om intercept to account for within-subject variability . Results : Fifty-one subjects ( SIM , 25 ; MAN , 26 ) completed all phases . The PRE performance was similar between groups . Both groups demonstrated improvement in POST performance . The improvement in scores between PRE and POST phases was significantly better in the SIM group ( mean [ SD ] , 11.1 [ 4.8 ] vs. 4.8 [ 1.7 ] , P = 0.007 ) . Conclusions : The use of high-fidelity simulation in a PALS training session result ed in improved cognitive performance by pediatric house staff . Future studies should address skill and knowledge decays and team dynamics , and clearly defined and reproducible outcome measures should be sought AIM Advanced simulation tools are increasingly being incorporated into cardiopulmonary resuscitation ( CPR ) training . These educational methods have been shown to improve trainee performance in simulated setting s , but translation into clinical practice remains unknown for many aspects of CPR quality . This study attempts to measure the impact of simulation-based training for resuscitation team leaders on some measures of CPR quality during actual in-hospital resuscitation attempts . METHODS In this prospect i ve , r and omized interventional cluster trial , internal medicine resident physicians ( post-graduate year 2 ) were r and omized using a r and om number generator to participate in a 4-h , immersive simulation course in cardiopulmonary resuscitation leadership using a high-fidelity simulator with video debriefing prior to serving as resuscitation team leaders at an academic medical center . Objective metrics of actual resuscitation performance were obtained from a CPR-sensing monitor/defibrillator . RESULTS Thirty-two residents were r and omized to receive simulation training or no additional training between April and July 2007 and data were collected following 98 actual resuscitations between July 2007 and June 2008 . CPR quality from resuscitations led by 14 simulation-trained and 16 control group residents was similar in terms of mean compression depth ( 48 vs 49 mm ; p = 0.53 ) ; compression rate ( 107 vs 104 min⁻¹ ; p = 0.30 ) ; ventilation rate ( 12 vs 12 min⁻¹ ; p = 0.45 ) and no-flow fraction ( 0.08 vs 0.07 ; p = 0.34 ) . CONCLUSIONS Although we failed to detect any significant differences in objective measures of CPR quality , we have demonstrated that CPR-sensing technology has the potential for use in assessing the impact of a simulation curriculum on some aspects of actual resuscitation performance . A larger study , performed in a setting with lower baseline performance , would be required to assess the specific simulation curriculum Objective To investigate the effect of in situ simulation ( ISS ) versus off-site simulation ( OSS ) on knowledge , patient safety attitude , stress , motivation , perceptions of simulation , team performance and organisational impact . Design Investigator-initiated single-centre r and omised superiority educational trial . Setting Obstetrics and anaesthesiology departments , Rigshospitalet , University of Copenhagen , Denmark . Participants 100 participants in teams of 10 , comprising midwives , specialised midwives , auxiliary nurses , nurse anaesthetists , operating theatre nurses , and consultant doctors and trainees in obstetrics and anaesthesiology . Interventions Two multiprofessional simulations ( clinical management of an emergency caesarean section and a postpartum haemorrhage scenario ) were conducted in teams of 10 in the ISS versus the OSS setting . Primary outcome Knowledge assessed by a multiple choice question test . Exploratory outcomes Individual outcomes : scores on the Safety Attitudes Question naire , stress measurements ( State-Trait Anxiety Inventory , cognitive appraisal and salivary cortisol ) , Intrinsic Motivation Inventory and perceptions of simulations . Team outcome : video assessment of team performance . Organisational impact : suggestions for organisational changes . Results The trial was conducted from April to June 2013 . No differences between the two groups were found for the multiple choice question test , patient safety attitude , stress measurements , motivation or the evaluation of the simulations . The participants in the ISS group scored the authenticity of the simulation significantly higher than did the participants in the OSS group . Expert video assessment of team performance showed no differences between the ISS versus the OSS group . The ISS group provided more ideas and suggestions for changes at the organisational level . Conclusions In this r and omised trial , no significant differences were found regarding knowledge , patient safety attitude , motivation or stress measurements when comparing ISS versus OSS . Although participant perception of the authenticity of ISS versus OSS differed significantly , there were no differences in other outcomes between the groups except that the ISS group generated more suggestions for organisational changes . Trial registration number NCT01792674 Background  Newborn deaths comprise nearly half of under-5 deaths in Ghana , despite the fact that skilled birth attendants ( SBAs ) are present at 68 % of births , which implies that evidence -based care during labor , birth and the immediate postnatal period may be deficient . We assessed the effect of a low-dose , high-frequency ( LDHF ) training approach on long-term evidence -based skill retention among SBAs and impact on adverse birth outcomes . Methods From 2014 to 2017 , we conducted a cluster-r and omized trial in 40 hospitals in Ghana . Eligible hospitals were stratified by region and r and omly assigned to one of four implementation waves . We assessed the relative risks ( RRs ) of institutional intrapartum stillbirths and 24-h newborn mortality in months 1–6 and 7–12 of implementation as compared to the historical control period , and in post-intervention facilities compared to pre-intervention facilities during the same period . All SBAs providing labor and delivery care were invited to enroll ; their knowledge and skills were assessed pre- and post-training , and 1 year later . Results Adjusting for region and health facility type , the RR of 24-h newborn mortality in the 40 enrolled hospitals was 0·41 ( 95 % CI 0·32–0·51 ; p < 0.001 ) in months 1–6 and 0·30 ( 95 % CI 0·21–0·43 ; p < 0·001 ) in months 7–12 compared to baseline . The adjusted RR of intrapartum stillbirth was 0·64 ( 95 % CI 0·53–0·77 ; p < 0·001 ) in months 1–6 and 0·48 ( 95 % CI 0·36–0·63 ; p < 0·001 ) in months 7–12 compared to baseline . Four hundred three SBAs consented and enrolled . After 1 year , 200 SBAs assessed had 28 % ( 95 % CI 25–32 ; p < 0·001 ) and 31 % ( 95 % CI 27–36 ; p < 0·001 ) higher scores than baseline on low-dose 1 and 2 content skills , respectively . Conclusions This training approach results in a sustained decrease in facility-based newborn mortality and intrapartum stillbirths , and retained knowledge and skills among SBAs after a year . We recommend use of this approach for future maternal and newborn health in-service training and programs . Trial registration Retrospectively registered on 25 September 2017 at Clinical Trials , identifier NCT03290924 Background Fetal and neonatal mortality rates in low-income countries are at least 10-fold greater than in high-income countries . These differences have been related to poor access to and poor quality of obstetric and neonatal care . Methods This trial tested the hypothesis that teams of health care providers , administrators and local residents can address the problem of limited access to quality obstetric and neonatal care and lead to a reduction in perinatal mortality in intervention compared to control locations . In seven geographic areas in five low-income and one middle-income country , most with high perinatal mortality rates and substantial numbers of home deliveries , we performed a cluster r and omized non-masked trial of a package of interventions that included community mobilization focusing on birth planning and hospital transport , community birth attendant training in problem recognition , and facility staff training in the management of obstetric and neonatal emergencies . The primary outcome was perinatal mortality at ≥28 weeks gestation or birth weight ≥1000 g. Results Despite extensive effort in all sites in each of the three intervention areas , no differences emerged in the primary or any secondary outcome between the intervention and control clusters . In both groups , the mean perinatal mortality was 40.1/1,000 births ( P = 0.9996 ) . Neither were there differences between the two groups in outcomes in the last six months of the project , in the year following intervention cessation , nor in the clusters that best implemented the intervention . Conclusions This cluster r and omized comprehensive , large-scale , multi-sector intervention did not result in detectable impact on the proposed outcomes . While this does not negate the importance of these interventions , we expect that achieving improvement in pregnancy outcomes in these setting s will require substantially more obstetric and neonatal care infrastructure than was available at the sites during this trial , and without them provider training and community mobilization will not be sufficient . Our results highlight the critical importance of evaluating outcomes in r and omized trials , as interventions that should be effective may not be . Trial registration Clinical Trials.gov Objective : To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum . Setting : Level 1 trauma center and academic emergency medicine training program . Participants : Emergency department ( ED ) staff including nurses , technicians , emergency medicine residents , and attending physicians . Intervention : : ED staff who had recently received didactic training in the Emergency Team Coordination Course ( ETCC ® )  also received an 8 hour intensive experience in an ED simulator in which three scenarios of graduated difficulty were encountered . A comparison group , also ETCC trained  , was assigned to work together in the ED for one 8 hour shift . Experimental and comparison teams were observed in the ED before and after the intervention . Design : Single , crossover , prospect i ve , blinded and controlled observational study . Teamwork ratings using previously vali date d behaviorally anchored rating scales ( BARS ) were completed by outside trained observers in the ED . Observers were blinded to the identification of the teams . Results : There were no significant differences between experimental and comparison groups at baseline . The experimental team showed a trend towards improvement in the quality of team behavior ( p = 0.07 ) ; the comparison group showed no change in team behavior during the two observation periods ( p = 0.55 ) . Members of the experimental team rated simulation based training as a useful educational method . Conclusion : High 
    Output:
    
We are uncertain if there are any benefits of interactive training of healthcare providers  on the management of life-threatening emergencies in hospital as the certainty of the evidence is very low .
We were unable to identify any factors that may have allowed us to identify an essential element of these interactive training courses .