***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: STUDY OBJECTIVE We conducted a prospect i ve , r and omized , controlled trial to test the hypothesis that a 34-minute video self-instruction ( VSI ) training program for adult CPR would yield comparable or better CPR performance than the current community st and ard , the American Heart Association Heartsaver course . METHODS Incoming freshman medical students were r and omly assigned to VSI or the Heartsaver CPR course .  Two to 6 months after training , we tested subjects to determine their ability to perform CPR in a simulated cardiac arrest setting . Blinded observers used explicit criteria to assess our primary outcome , CPR performance skill . In addition , we assessed secondary outcomes including sequential performance of individual skills , ventilation and chest compression characteristics , and written tests of CPR-related knowledge and attitudes . RESULTS VSI trainees displayed superior overall performance compared with traditional trainees . Twenty of 47 traditional trainees ( 43 % ) were judged not competent in their performance of CPR , compared with only 8 of 42 VSI trainees ( 19 % ; absolute difference , 24 % ; 95 % confidence interval , 5 % to 42 % ) . CONCLUSION In a group of incoming freshman medical students , we found that a half-hour of VSI result ed in superior overall CPR performance compared with that in traditional trainees . If vali date d by further research , VSI may provide a simple , quick , and inexpensive alternative to traditional CPR instruction for health care workers and , perhaps , the general population STUDY OBJECTIVE Despite the proven efficacy of cardiopulmonary resuscitation ( CPR ) , only a small fraction of the population knows how to perform it . As a result , rates of byst and er CPR and rates of survival from cardiac arrest are low . Byst and er CPR is particularly uncommon in the African American community . Successful development of a simplified approach to CPR training could boost rates of byst and er CPR and save lives . We conducted the following r and omized , controlled study to determine whether video self-instruction ( VSI ) in CPR results in comparable or better performance than traditional CPR training . METHODS This r and omized , controlled trial was conducted among congregational volunteers in an African American church in Atlanta , GA . Subjects were r and omly assigned to receive either 34 minutes of VSI or the 4-hour American Heart Association " Heartsaver " CPR course . Two months after training , blinded observers used explicit criteria to assess CPR performance in a simulated cardiac arrest setting . A recording manikin was used to measure ventilation and chest compression characteristics . Participants also completed a written test of CPR-related knowledge and attitudes . RESULTS VSI trainees displayed a comparable level of performance to that achieved by traditional trainees . Observers scored 40 % of VSI trainees competent or better in performing CPR , compared with only 16 % of traditional trainees ( absolute difference 24 % , 95 % confidence interval 8 % to 40 % ) . Data from the recording manikin confirmed these observations . VSI trainees and traditional trainees achieved comparable scores on tests of CPR-related knowledge and attitudes . CONCLUSION Thirty-four minutes of VSI can produce CPR of comparable quality to that achieved by traditional training methods . VSI provides a simple , quick , consistent , and inexpensive alternative to traditional CPR instruction , and may be used to extend CPR training to historically underserved population BACKGROUND Byst and er CPR improves outcomes after out of hospital cardiac arrest . The length of current 4-h classes in cardiopulmonary resuscitation ( CPR ) is a barrier to more widespread dissemination of CPR training and older adults in particular are underrepresented in traditional classes . Training with a brief video self-instruction ( VSI ) program has shown that this type of training can produce short-term skill performance at least as good as that seen with traditional American Heart Association ( AHA ) Heartsaver training , although it is unclear whether there is comparable skill retention . METHODS AND RESULTS Two hundred and eight-five adults between the ages of 40 and 70 who had no CPR training within the past 5 years were assigned at r and om to a no-training control group , Heartsaver ( HS ) training , or one of three versions of brief VSI ( i.e. , self-trained-ST subjects ) . Post-training performance of CPR skills was assessed in a scenario format by human examiners and by sensored manikin at Time 1 ( immediately post-training ) and again at Time 2 ( 2 months post-training ) . Performance by controls was assessed only once . Significant ( P<.001 ) decline was observed in the three measures recorded by examiners ; assess responsiveness ( from 72 % to 60 % for HS subjects and from 90 % to 77 % for ST subjects ) , call 911 ( from 82 % to 74 % for HS subjects and from 71 % to 53 % for ST subjects ) , and overall performance ( from 42 % to 30 % for HS subjects and from 60 % to 44 % for ST subjects ) . Significant ( P<.001 ) decline was observed in two of three skills measured by a sensored manikin : ventilation volume ( from 40 % to 36 % for HS subjects and from 61 % to 41 % for ST subjects , with a significant [ P=.028 ] interaction ) and correct h and placement ( from 68 % to 59 % for HS subjects and from 80 % to 64 % for ST subjects ) . Heartsaver and self-trained subjects generally showed similar rates of decline . At Time 2 , examiners rated trained subjects better than untrained controls in all skills except calling 911 , where self-trained subjects did not differ from controls ; manikin data revealed that trained subjects ' performance was better than that of controls for ventilation volume , but had declined to the level of controls for both h and placement and compression depth . CONCLUSIONS Adults between 40 and 70 years of age who participated in a CPR VSI program experienced performance decline in their CPR skills after a post-training interval of 2 months . However , this decline was no greater than that seen in subjects who took Heartsaver training . The VSI program produced retention performance at least as good as that seen with traditional training . Additional effort is needed to improve both initial performance and retention of CPR skills . CONDENSED ABSTRACT Retention of CPR skills was compared 2 months post-training for adults between 40 and 70 years old who had taken either a traditional Heartsaver CPR course or a 22-min video self-directed training course .  Although performance declines occurred in the 2-month interval , self-trained subjects generally demonstrated CPR skill retention equivalent to that of Heartsaver-trained subjects , although for both groups skill decline on some measures reached the level of untrained controls OBJECTIVES / PURPOSE To test registered nurses ' abilities to retain basic or advanced life support psychomotor skills  and theoretical knowledge . DESIGN A repeated- measures , quasi-experimental design was used . METHODS Written and performance tests ( initial , post-training , and final testing ) used scenarios requiring performance of advanced cardiac life support ( ACLS ) or basic life support ( BLS ) skills . Final testing was by r and om assignment to 3 , 6 , 9 , or 12 months . SAMPLE A convenience sample ( n=133 ) was used . INSTRUMENTATION American Heart Association 2000 ACLS and BLS evaluation tools  were used in a simulated testing environment . FINDINGS Findings show nurses  retain theoretical knowledge but performance skills de grade quickly . ACLS skills de grade faster than BLS skills with 63 % passing BLS at 3 months and 58 % at 12 months . Only 30 % of participants passed ACLS skills at 3 months and 14 % at 12 months . These findings are similar to the results of other investigators in over a decade of research . CONCLUSIONS Study results showed a decline in skills retention with nurses unable to perform ACLS and BLS skills to st and ard for the entire certification period . The need for more frequent refresher training is needed . No formal research at this institution indicates skill degradation adversely affected patient outcomes . Further research on  ACLS and BLS  course content , design , management , and execution is needed INTRODUCTION The optimal strategy to retrain basic life support ( BLS ) skills on a manikin is unknown . We analysed the differential impact of a video ( video group , VG ) , voice feedback ( VFG ) , or a serial combination of both ( combined group , CG ) on BLS skills in a self-learning ( SL ) environment . METHODS Two hundred and thirteen medicine students were r and omly assigned to a VG , a VFG and a CG . The VG refreshed the skills with a practice -while-watching video ( abbreviated Mini Anne ™ video , Laerdal , Norway ) and a manikin , the VFG with a computer-guided manikin ( Resusci Anne Skills Station ™ , Laerdal , Norway ) and the CG with a serial combination of both . Each student performed two sequences of 60 compressions , 12 ventilations and three complete cycles of BLS ( 30:2 ) . The proportions of students achieving adequate skills were analysed using generalised estimating equations analysis , taking into account pre-test results and training strategy . RESULTS Complete data sets were obtained from 192 students ( 60 VG , 69 VFG and 63 CG ) . Before and after training , ≥70 % of compressions with depth ≥50 mm were achieved by 14/60 ( 23 % ) vs. 16/60 ( 27 % ) VG , 24/69 ( 35 % ) vs. 50/69 ( 73 % ) VFG and 19/63 ( 30 % ) vs. 41/63 ( 65 % ) CG ( P<0.001 ) . Compression rate 100 - 120/min was present in 27/60 ( 45 % ) vs. 52/60 ( 87 % ) VG , 28/69 ( 41 % ) vs. 44/69 ( 64 % ) VFG and 27/63 ( 43 % ) vs. 42/63 ( 67 % ) CG ( P=0.05 ) . Achievement of ≥70 % ventilations with a volume 400 - 1000 ml was present in 29/60 ( 49 % ) vs. 32/60 ( 53 % ) VG , 32/69 ( 46 % ) vs. 52/69 ( 75 % ) VFG and 25/63 ( 40 % ) vs. 51/63 ( 81 % ) CG ( P=0.001 ) . There was no between-groups difference for complete release . CONCLUSIONS Voice feedback and a sequential combination of video and voice feedback are both effective strategies to refresh BLS skills in a SL station . Video training alone only improved compression rate . None of the three strategies result ed in an improvement of complete release AIM To evaluate the retention of skills 6 months after training in ventilation and chest compressions ( CPR ) on a manikin with computer based on-line voice advisory feedback and the possible effects of initial overtraining . METHODS Thirty five volunteers had 20 min provisional CPR training on a manikin with computer based voice advisory feedback but without an instructor . The appropriate feedback was taken from a pre-recorded list depending on performance measured by the manikin -- computer system versus set limits for ventilation and compression variables . One group in addition was r and omised to receive 10 similar 3 min training sessions during 1 week in the following month ( overtrained group ) . All ventilation and compression variables were measured without feedback before and after the initial training session , with feedback immediately thereafter , and both without and with feedback 6 months after the initial training session . RESULTS The initial training improved all variables . Compressions with correct depth increased from a mean of 33 to 77 % , and correct inflations from a mean of 9 to 58 % . After 6 months , the results for the controls were not significantly different from pre-training , except for a higher of correct inflations ( 18 % ) , while the overtrained group had better retention of skills including the correct compression depth ( mean 61 % ) and inflations ( mean 42 % ) . When verbal feedback was added both the compressions and ventilations immediately improved both when tested immediately and 6 months after the initial training session . CONCLUSIONS The computer-based voice advisory manikin ( VAM ) feedback system can improve immediate performance of basic life support ( BLS ) skills , with better long-term retention with overtraining BACKGROUND Each year , more than 1.5 million health care professionals receive advanced life support ( ALS ) training .  OBJECTIVE To determine whether a blended approach to ALS training that includes electronic learning ( e-learning ) produces outcomes similar to those of conventional , instructor-led ALS training . DESIGN Open-label , noninferiority , r and omized trial . R and omization , stratified by site , was generated by Sealed Envelope ( Sealed Envelope , London , United Kingdom ) . ( International St and ardized R and omized Controlled Trial Number Register : ISCRTN86380392 ) SETTING 31 ALS centers in the United Kingdom and Australia . PARTICIPANTS 3732 health care professionals recruited between December 2008 and October 2010 . INTERVENTION A 1-day course supplemented with e-learning versus a conventional 2-day course . MEASUREMENTS The primary outcome was performance in a cardiac arrest simulation test at the end of the course . Secondary outcomes comprised knowledge- and skill-based assessment s , repeated assessment after remediation training , and re source use . RESULTS 440 of the 1843 participants r and omly assigned to the blended course and 444 of the 1889 participants r and omly assigned to conventional training did not attend the courses . Performance in the cardiac arrest simulation test after course attendance was lower in the electronic advanced life support ( e-ALS ) group compared with the conventional advanced life support ( c-ALS ) 
    Output:
    
With the increasing pressure of re sources and time , tradiional instructor led courses may not be the most efficient method or delivering resuscitation training to sharp end CPR providers .
The automated voice feedback/prompt ystem used a computer-guided manikin with automated