***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: Objective : To evaluate the viability and effectiveness of a simulation-based pediatric mock code program on patient outcomes , as well as residents ' confidence in performing resuscitations . A resident 's leadership ability is integral to accurate and efficient clinical response in the successful management of cardiopulmonary arrest ( CPA ) . Direct experience is a contributing factor to a resident 's code team leadership ability ; however , opportunities to gain experience are limited by relative infrequency of pediatric arrests and code occurrences when residents are on service . Design : Longitudinal , mixed- methods research design . Setting : Children 's hospital at an tertiary care academic medical center . Patients : Pediatric . Interventions : Clinicians responsible for pediatric resuscitations responded to mock codes r and omly called at increasing rates over a 48-month period , just as they would an actual CPA event . Events were recorded and used for immediate debriefing facilitated by clinical faculty to provide residents feedback about their performance . Measurements : Self- assessment data were collected from all team members . Hospital records for pediatric CPA survival rates were examined for the study duration . Results : Survival rates increased to approximately 50 % ( p = .000 ) , correlating with the increased number of mock codes ( r = .87 ) . These results are significantly above the average national pediatric CPA survival rates and held steady for 3 consecutive years , demonstrating the stability of the program 's outcomes . Conclusions : This study suggests that a simulation-based mock code program may significantly benefit pediatric patient CPA outcomes —applied clinical outcomes —not simply learner perceived value , increased confidence , or simulation-based outcomes . The use of mock codes as an integral part of residency programs could provide residents with the resuscitation training they require to become proficient in their practice . Future programs that incorporate transport scenarios , ambulatory care , and other outpatient setting s could further benefit pediatric patients in prehospital context Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement 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 This study examines effectiveness of a donated Laerdal Virtual I.V. simulator when compared with traditional methods of teaching intravenous ( IV ) cannulation to third year medical students in the Philippines . Forty novice Filipino medical students viewed an instructional video on how to start intravenous lines and were then r and omly divided into two groups of twenty . The " Traditional " group observed an IV insertion on an actual patient performed by an experienced practitioner , and then subsequently performed an IV on an actual patient which was videotaped . The " Simulation " group practice d the Virtual I.V. simulator until they successfully completed level three using the " doctor " setting . These students then performed an IV on an actual patient which was videotaped . The videotapes for both groups were review ed by two pre-trained ( Inter-rater reliability of > or = 0.84 ) observers who were blinded to the group using a previously vali date d checklist for IV insertion . Students trained on the Virtual I.V. showed significantly greater success in successfully starting an IV on an actual patient ( 40 % VS . 15 % , p<0.05 ) , decreased constrictive b and time ( p<.05 ) , increased raw score on the check list ( p<.03 ) , and decreased overall time to start an IV ( p<.05 ) . The technology was well received but wider application in the non western world is limited by lack of in country company support and the relative expense Background With increasing pressure to use operating room time efficiently , opportunities for residents to learn fiberoptic orotracheal intubation in the operating room have declined . The purpose of this study was to determine whether fiberoptic orotracheal intubation skills learned outside the operating room on a simple model could be transferred into the clinical setting . Methods First-year anesthesiology residents and first- and second-year internal medicine residents were recruited . Subjects were r and omized to a didactic-teaching-only group ( n = 12 ) or a model-training group ( n = 12 ) . The didactic-teaching group received a detailed lecture from an expert bronchoscopist . The model-training group was guided , by experts , through tasks performed on a simple model design ed to refine fiberoptic manipulation skills . After the training session , subjects performed a fiberoptic orotracheal intubation on healthy , consenting , anesthetized , paralyzed female patients undergoing elective surgery with predicted “ easy ” laryngoscopic intubations . Two blinded anesthesiologists evaluated each subject . Results After the training session , the model group significantly outperformed the didactic group in the operating room when evaluated with a global rating scale ( P < 0.01 ) and checklist ( P < 0.05 ) . Model-trained subjects completed the fiberoptic orotracheal intubation  significantly faster than didactic-trained subjects ( P < 0.01 ) . Model-trained subjects were also more successful at achieving tracheal intubation than the didactic group ( P < 0.005 ) . Conclusion Fiberoptic orotracheal intubation skills training on a simple model is more effective than conventional didactic instruction for transfer to the clinical setting . Incorporating an extraoperative model into the training of fiberoptic orotracheal intubation may greatly reduce the time and pressures that accompany teaching this skill in the operating room 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 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 in medical simulation seem promising with regard to the possibility of " training out " undesirable parts of the learning curve outside the operating room . The aim of this study was to investigate whether the use of the AccuTouch flexible endoscopy simulator improves the early part of the learning curve in colonoscopy training . METHOD 12 endoscopy trainees , 10 surgeons and two medical gastroenterologists , all with experience in gastroscopy but with no specific colonoscopy experience , were r and omly assigned to either simulator training or to a control group . They all received the same theoretical study package and the training group practice d with the AccuTouch colonoscopy simulator until a predefined expert level of performance was reached . All trainees performed their first ten individual colonoscopies described in detail in a separate protocol . RESULTS Trainees in the simulator-trained group performed significantly better ( P=0.0011 ) and managed to reach the cecum in 52 % of their cases ( vs. 19 % in the control group ) , and were 4.53 times more likely to succeed compared with the controls . Additionally , there was a significantly shorter procedure time and less patient discomfort in the h and s of the simulator-trained group . 
    Output:
    
CONCLUSIONS Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction , although the latter did not reach statistical significance .