***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: 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 BACKGROUND Temporary hemodialysis catheter ( THDC ) insertion is a required skill for nephrology fellows . Traditional fellowship training may provide inadequate preparation to perform this procedure . Our aim was to use a central venous catheter ( CVC ) simulator to assess nephrology fellows ' THDC insertion skills and evaluate the impact of an educational intervention on skill development to mastery st and ards . STUDY DESIGN Prospect i ve observational cohort study . SETTING & PARTICIPANTS 18 nephrology fellows from 3 academic centers in Chicago from May to August 2008 . Six graduating fellows ( traditionally-trained ) underwent assessment of internal jugular THDC insertion skill using a CVC simulator . Subsequently , 12 first-year fellows ( simulator-trained ) underwent baseline testing and received a 2-hour education session featuring deliberate practice with the CVC simulator . Simulator-trained fellows were retested after the intervention and expected to meet or exceed a minimum passing score . PREDICTOR Completion of CVC simulation education session . OUTCOMES THDC insertion skill performance . MEASUREMENTS Skills examination was scored on a 27-item checklist . Minimum passing score was set by an expert panel . RESULTS Performance of traditionally-trained graduating fellows in THDC insertion was poor ( mean , 53.1 % ) , and only 17 % met the minimum passing score . Performance of simulator-trained first-year fellows improved from a mean of 29.5 % to a mean of 88.6 % after simulator training ( P = 0.002 ) . Simulator-trained fellows showed significantly higher THDC insertion performance than traditionally-trained graduating fellows ( P = 0.001 ) . The education program was rated highly . LIMITATIONS Although it represents fellows from 3 programs , sample size was small . CONCLUSIONS A curriculum featuring deliberate practice dramatically increased the skill of nephrology fellows to mastery st and ards in THDC insertion . This program illustrates a feasible and reliable mechanism to achieve and document procedural competency Objective : To assess the impact of warm-up on laparoscopic performance in the operating room ( OR ) . Background : Implementation of simulation-based training into clinical practice remains limited despite evidence to show that the improvement in skills is transferred to the OR . The aim of this study was to evaluate the impact of a short virtual reality warm-up training program on laparoscopic performance in the OP . Methods : Sixteen Laparoscopic Cholecystectomies were performed by 8 surgeons in the OR . Participants were r and omized to a group which received a preprocedure warm-up using a virtual reality simulator and no warm-up group . After the initial laparoscopic cholecystectomy all surgeons served as their own controls by performing another procedure with or without preoperative warm-up . All OR procedures were videotaped and assessed by 2 independent observers using the generic OSATS global rating scale ( from 7 to 35 ) . Results : There was significantly better surgical performance on the laparoscopic Cholecystectomy following preoperative warm-up , median 28.5 ( range = 18.5–32.0 ) versus median 19.25 ( range = 15–31.5 ) , P = 0.042 . The results demonstrated excellent reliability of the assessment tool used ( Cronbach 's & agr ; = 0.92 ) . Conclusion : This study showed a significant beneficial impact of warm-up on laparoscopic performance in the OP . The suggested program is short , easy to perform , and therefore realistic to implement in the daily life in a busy surgical department . This will potentially improve the procedural outcome and contribute to improved patient safety and better utilization of OR re sources OBJECTIVE To assess two physician learning interventions design ed to improve safety and quality of diabetes care delivered by primary care physicians ( PCPs ) . RESEARCH DESIGN AND METHODS This group r and omized clinical trial included 57 consenting PCPs and their 2,020 eligible adult patients with diabetes . Physicians were r and omized to no intervention ( group A ) , a simulated case-based physician learning intervention ( group B ) , or the same simulated case-based learning intervention with physician opinion leader feedback ( group C ) . Dependent variables included A1C values , LDL cholesterol values , pharmacotherapy intensification rates in patients not at clinical goals , and risky prescribing events . RESULTS Groups B and C had substantial reductions in risky prescribing of metformin in patients with renal impairment ( P = 0.03 ) . Compared with groups A and C , physicians in group B achieved slightly better glycemic control ( P = 0.04 ) , but physician intensification of oral glucose-lowering medications was not affected by interventions ( P = 0.41 ) . Lipid management improved over time ( P < 0.001 ) but did not differ across study groups ( P = 0.67 ) . CONCLUSIONS A simulated , case-based learning intervention for physicians significantly reduced risky prescribing events and marginally improved glycemic control in actual patients . The addition of opinion leader feedback did not improve the learning intervention . Refinement and further development of this approach is warranted BACKGROUND We studied the reasons why patients undergoing thoracenteses performed in our outpatient pulmonary clinic had a higher frequency of  iatrogenic pneumothorax  compared to that in the concurrent radiology practice in our institution , which utilizes ultrasound guidance . We review ed our practice model and implemented a unique experiential training paradigm in a zero-risk simulation environment to improve efficacy , timeliness , service orientation , and safety . METHODS We retrospectively determined the rate of clinical ly significant pneumothoraces in our practice ( phase I , July 1 , 2001 , to June 30 , 2002 ) . The training system re design included the following : ( 1 ) a design ated group of pulmonologist instructors dedicated to treating pleural disease and reducing the number of iatrogenic complications ; ( 2 ) the use of ultrasound image guidance for all thoracenteses ; and ( 3 ) structured proficiency and competency st and ards for proceduralists . Postintervention ( phase II ) data were prospect ively collected ( January 2005 to December 2006 ) and compared with our baseline data . RESULTS The baseline rate of pneumothorax was 8.6 % ( 5 of 58 patients ) in our pulmonary practice . Following intervention ( phase II ) , the rate of pneumothorax declined to 1.1 % ( p = 0.0034 ) . During phase II , the number of thoracenteses performed increased ( 186 vs 58 per year , respectively ; p < 0.05 ) . The iatrogenic pneumothorax rate was stable in the 2 years following intervention ( 2005 , 0.7 % [ 1 of 137 pneumothoraces ] ; 2006 , 1.3 % [ 3 of 226 pneumothoraces ] ; p > 0.9 ) . Postintervention complications included procedure-related pain ( n = 19 ) , cough ( n = 4 ) , and hypotension ( n = 10 ) . CONCLUSIONS An improvement program that included simulation , ultrasound guidance , competency testing , and performance feedback reduced iatrogenic risk to patients . We recommend application of this process to procedural practice Purpose To determine whether simulation training of ultrasound (US)-guided central venous catheter ( CVC ) insertion skills on a partial task trainer improves cannulation and insertion success rates in clinical practice . Method This prospect i ve , r and omized , controlled , single-blind study of first- and second-year residents occurred at a tertiary care teaching hospital from January 2007 to September 2008 . The intervention group ( n = 90 ) received a didactic and h and s-on , competency-based simulation training course in US-guided CVC insertion , whereas the control group ( n = 95 ) received training through a traditional , bedside apprenticeship model .  Success at first cannulation and successful CVC insertion served as the primary outcomes . Secondary outcomes included reduction in technical errors and decreased mechanical complications . Results Blinded independent raters observed 495 CVC insertions by 115 residents over a 21-month period . Successful first cannulation occurred in 51 % of the intervention group versus 37 % of the control group ( P = .03 ) . CVC insertion success occurred for 78 % of the intervention group versus 67 % of the control group ( P = .02 ) . Simulation training was independently and significantly associated with success at first cannulation ( odds ratio : 1.7 ; 95 % confidence interval : 1.1–2.8 ) and with successful CVC insertion ( odds ratio : 1.7 ; 95 % confidence interval : 1.1–2.8)—both independent of US use , patient comorbidities , or resident specialty . No significant differences related to technical errors or mechanical complications existed between the two groups . Conclusions Simulation training was associated with improved in-hospital performance of CVC insertion . Procedural simulation was associated with improved residents ' skills and was more effective than traditional training Background : Simulation-based training is useful in improving physicians ' skills . However , no r and omized controlled trials have been able to demonstrate the effects of simulation teaching in real-life patient care . This study aim ed to determine whether simulation-based training or an interactive seminar result ed in better patient care during weaning from cardiopulmonary bypass (CPB)—a high stakes clinical setting . Methods : This study was conducted as a prospect i ve , single-blinded , r and omized controlled trial . After institutional research board approval , 20 anesthesiology trainees , postgraduate year 4 or higher , inexperienced in CPB weaning , and 60 patients scheduled for elective coronary artery bypass grafting were recruited . Each trainee received a teaching syllabus for CPB weaning 1 week before attempting to wean a patient from CPB ( pretest ) . One week later , each trainee received a 2-h training session with either high-fidelity simulation-based training or a 2-h interactive seminar . Each trainee then weaned patients from CPB within 2 weeks ( posttest ) and 5 weeks ( retention test ) from the intervention . Clinical performance was measured using the vali date d Anesthesiologists ' Nontechnical Skills Global Rating Scale and a checklist of expected clinical actions . Results : Pretest Global Rating Scale and checklist performances were similar . The simulation group scored significantly higher than the seminar group at both posttest ( Global Rating Scale [ mean ± st and ard error ] : 14.3 ± 0.41 vs. 11.8 ± 0.41 , P < 0.001 ; checklist : 89.9 ± 3.0 % vs. 75.4 ± 3.0 % , P = 0.003 ) and retention test ( Global Rating Scale : 14.1 ± 0.41 vs. 11.7 ± 0.41 , P < 0.001 ; checklist : 93.2 ± 2.4 % vs. 77.0 ± 2.4 % , P < 0.001 ) . Conclusion : Skills required to wean a patient from CPB can be acquired through simulation-based training . Compared with traditional interactive seminars , simulation-based training leads to improved performance in patient care by senior trainees in anesthesiology BACKGROUND AND STUDY AIM As for any manual procedure , the learning curves for medical interventions can have undesirable phases , occurring mostly in the early experience of applying a technique . There have been impressive advances in endoscopic procedures during recent years , and there is an emerging trend that the number of procedures is increasing in parallel with these . In addition , the introduction of screening programs for colorectal cancer will also increase the numbers of procedures needed . Recent developments 
    Output:
    
Studies varied widely in the quality of method ological design and description of simulation activities , but in general , simulation interventions improved the technical performance of individual clinicians and teams during critical events and complex procedures .
Limited evidence suggested improvements in patient outcomes attributable to simulation exercises at the health system level .