***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 : Few data exist on successes at reducing  pediatric catheter-associated bloodstream infections ( CA-BSI ) .  The objective was to eradicate CA-BSI with a multifaceted pediatric-relevant intervention proven effective in adult patients . Design : Prospect i ve cohort of pediatric intensive care ( PICU ) patients with historical controls . Setting : Multidisciplinary PICU . Patients / Participants : PICU patients with intervention targeting PICU providers . Interventions : Multifaceted intervention involving preintervention staff surveys , provider educational program , creation of central catheter procedure cart , guideline -supported central catheter insertion checklist , nursing staff empowerment to stop procedures that breached guidelines , and real-time data feedback to PICU leadership . Measurements and Main Results : We measured rate of CA-BSI per 1000 catheter days from August 2001 through September 2006 . Reliable use of evidence -based best practice s for insertion of central catheters in our PICU was associated with a statistically and clinical ly significant decrease in our CA-BSI rate for 24 months postintervention ( p < .05 ) . During a portion of this postintervention period , we experienced a dramatic increase in our CA-BSI rate that was ultimately found to be due to the introduction of a new positive displacement mechanical valve intravenous port in April 2004 . After removal of this positive displacement mechanical valve , our CA-BSI rate dropped from 5.2 ± 4.5 CA-BSI per 1000 central catheter days to a rate of 3.0 ± 1.9 CA-BSI per 1000 central catheter days . Chart review of postintervention CA-BSI cases revealed that these patients acquired CA-BSI weeks after both PICU admission and after insertion of the most recent central catheter . Conclusions : Our data show that improving practice s for insertion of central catheters leads to a reduction of CA-BSI  among pediatric patients but not elimination of CA-BSI . More research is needed to identify best practice s for maintenance of central catheters for children . In addition , our experience shows that even despite good interventions to control CA-BSI , institutions must remain vigilant to factors such as new technology with apparent advantages but short track records of use 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 determine the feasibility , efficacy , and outcomes of teaching Internal Jugular ( IJ ) central venous line placement ( CVLP ) to internal medicine residents in a h and s-on training experience with adult patients . SUBJECTS AND METHODS Data were obtained from 47 residents during their 3-year residency program through question naires and a proprietary system that tracks resident procedures . Twenty-five postgraduate year ( PGY ) 2 residents at the Mayo Clinic in Rochester , Minn , were assigned to IJ-CVLP training in the cardiac catheterization laboratory from January 2001 to June 2001 . Their experience , analyzed immediately after training and at completion of residency , was compared with that of 22 PGY-2 residents in the same class who were not assigned to IJ-CVLP training . RESULTS The median Likert scores of the residents ' self-reported perception of independence in IJ-CVLP increased from 3.0 ( mean + /- SD score , 2.8+/-1.4 ) before the intervention to 5.0 ( 4.4+/-0.9 ) after the intervention ( P<.001 , signed rank test ) . At graduation , trained residents had performed more IJ-CVLPs than the control residents ( mean + /- SD , 17.8+/-8.4 vs 9.8+/-6.3 , respectively ; P<.001 ) . Residents who received IJ-CVLP training , compared with those who did not , showed a significant increase in the mean percentage of IJ-CVLPs performed independently between PGY-1 ( 2.2 % ) and PGY-3 ( 31.2 % ) ( P=.008 ) . CONCLUSIONS Training internal medicine residents to perform IJ-CVLP is feasible in the cardiac catheterization laboratory with supervision from an attending cardiologist . Trained residents performed significantly more IJ-CVLPs independently during their third year compared with their first year of training . We believe this initiative may be implemented successfully in graduate medical education curriculums OBJECTIVES Ultrasound guidance for central venous catheterization  improves success rates and decreases complications when compared to the l and mark technique . Prior research has demonstrated that arterial and /or posterior vein wall puncture still occurs despite real-time ultrasound guidance . The inability to maintain visualization of the needle tip may contribute to these complications . This study aims to identify whether long-axis or short-axis approaches to ultrasound-guided vascular access afford improved visibility of the needle tip . METHODS A prospect i ve trial was conducted at a level I trauma center with an emergency medicine residency . Medical students and residents placed needles into vascular access tissue phantoms using long-axis and short-axis approaches . Ultrasound images obtained at the time of vessel puncture were then review ed . Primary outcome measures were visibility of the needle tip at the time of puncture and total time to successful puncture of the vessel . RESULTS All subjects were able to successfully obtain simulated blood from the tissue phantom . Mean time to puncture was 14.8 seconds in the long-axis group and 12.4 seconds in the short-axis group ( P = .48 ) . Needle tip visibility at the time of vessel puncture was higher in the long-axis group ( 24/39 , 62 % ) as opposed to the short-axis group ( 9/39 , 23 % ) ( P = .01 ) . CONCLUSIONS In a simulated vascular access model , the long-axis approach to ultrasound-guided vascular access was associated with improved visibility of the needle tip during vessel puncture . This approach may help decrease complications associated with ultrasound-guided central venous catheterization and should be prospect ively evaluated in future studies BACKGROUND The teaching of surgical skills is based mostly on the traditional " see one , do one , teach one " resident-to-resident method . Surgical skills laboratories provide a new environment for teaching skills but their effectiveness has not been adequately tested . Cognitive task analysis is an innovative method to teach skills , used successfully in nonmedical fields . The objective of this study is to evaluate the effectiveness of a 3-hour surgical skills laboratory course on  central venous catheterization ( CVC )  , taught by the principles of cognitive task analysis to surgical interns . METHODS Upon arrival to the Department of Surgery , 26 new interns were r and omized to either receive a surgical skills laboratory course on CVC ( " course " group , n = 12 ) or not  ( " traditional " group , n = 14 ) . The course consisted mostly of h and s-on training on inanimate CVC models . All interns took a 15-item multiple-choice question test on CVC at the beginning of the study . Within two and a half months all interns performed CVC on critically ill patients . The outcome measures were cognitive knowledge and technical-skill competence on CVC . These outcomes were assessed by a 14-item checklist evaluating the interns while performing CVC on a patient and by the 15-item multiple-choice- question test  , which was repeated at that time . RESULTS There were no differences between the two groups in the background characteristics of the interns or the patients having CVC  . The scores at the initial multiple-choice test were similar ( course : 7.33 + /- 1.07 , traditional : 8 + /- 2.15 , P = 0.944 ) . However , the course interns scored significantly higher in the repeat test compared with the traditional interns ( 11 + /- 1.86 versus 8.64 + /- 1.82 , P = 0.03 ) . Also , the course interns achieved a higher score on the 14-item checklist ( 12.6 + /- 1.1 versus 7.5 + /- 2.2 , P < 0.001 ) . They required fewer attempts to find the vein ( 3.3 + /- 2.2 versus 6.4 + /- 4.2 , P = 0.046 ) and showed a trend toward less time to complete the procedure ( 15.4 + /- 9.5 versus 20.6 + /- 9.1 minutes , P = 0.149 ) . CONCLUSIONS A surgical skills laboratory course on CVC , taught by the principles of cognitive task analysis and using inanimate models , improves the knowledge and technical skills of new surgical interns on this task PURPOSE To evaluate the effectiveness of binary content checklists in measuring increasing levels of clinical competence . METHOD Fourteen clinical clerks , 14 family practice residents , and 14 family physicians participated in two 15-minute st and ardized patient interviews . An examiner rated each participant 's performance using a binary content checklist and a global process rating . The participants provided a diagnosis two minutes into and at the end of the interview . RESULTS On global scales , the experienced clinicians scored significantly better than did the residents and clerks , but on checklists , the experienced clinicians scored significantly worse than did the residents and clerks . Diagnostic accuracy increased for all groups between the two-minute and 15-minute marks without significant differences between the groups . CONCLUSION These findings are consistent with the hypothesis that binary checklists may not be valid measures of increasing clinical competence Objective : To evaluate the effect of an online training course containing video clips of central venous catheter insertions on compliance with sterile practice . Design : Prospect i ve r and omized controlled study . Setting : Admitting area of a university-based high-volume trauma center . Subjects : Surgical and emergency medicine residents rotating through the trauma services . Interventions : An online training course on recommended sterile practice s during central venous catheter insertion was developed . The course contained short video clips from actual patient care demonstrating common noncompliant behaviors and breaks regarding recommended sterile practice s. A 4-month study with a counterbalanced design compared residents trained by the video-based online training course ( video group )  with  those trained with a paper version of the course ( paper group ) .  Residents who inserted central venous catheters but received neither the paper nor video training  were used as a control group . Consecutive central venous catheter insertions from 12 noon to 12 midnight except Sundays were video recorded . Measurements and Main Results : Sterile- practice compliance was judged through video review by two surgeons blinded to the training status of the residents . Fifty residents inserted 73 elective central venous catheters ( 19 , 31 , and 23 by the video , paper , and control group operators , respectively ) into 68 patients .  Overall compliance with proper operator preparation , skin preparation , and draping was 49 % ( 36 of 73 procedures ) . The training had no effect on selection of site and skin preparation agent . The video group was significantly more likely than the other two groups to fully comply with sterile practice s ( 74 % vs. 33 % ; odds ratio , 6.1 ; 95 % confidence interval , 2.0–22.0 ) . Even after we controlled for the number of years in residency  training , specialty , number of central venous catheters inserted , and central venous catheter site chosen , the video group was more likely to comply with recommended sterile practice s ( p = .003 ) . Conclusions : An online training course , with short video clips of actual patient care demonstrating noncompliant behaviors , improved sterile- practice compliance for central venous catheter insertion . Paper h and outs with equivalent content did not improve compliance Objectives : To evaluate the frequency of unsuspected posterior vessel wall penetration of the internal jugular vein during  ultrasound-guided needle cannulation .  Design : Prospect i ve , single-blinded observational study . Setting : Urban level I emer 
    Output:
    
Conclusion This study presents a comprehensive review of existing checklist items for the assessment of central venous catheterization .
Although many key competencies are currently assessed by existing published tools , some domains may be under-represented by select tools