***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: Background : Previous studies have described that pediatric offices are ill-prepared for medical emergencies . Pediatric " mock codes " have been utilized to increase the emergency preparedness of inpatient medical units for several decades . These practice drills have been shown to both increase practitioners ' confidence and decrease anxiety during actual resuscitations . Although the use of mock codes is recommended in the outpatient setting , these benefits have yet to be demonstrated for office-based practitioners . Objective : We conducted this study to determine whether mock codes performed in pediatric primary care offices increase practitioner confidence to perform life-saving skills . Methods : Pediatric group practice s participated in a clinical trial of an office-based , 2-step , emergency preparedness training . First , physicians and staffs attended a 1-hour didactic program which included staff education , office emergency protocol s , emergency equipment and medications , and guidelines on instituting a mock code program . Second , each practice participated in a 10 - 15-minute mock code exercise . The drill was conducted by pediatric advanced life support instructors . After the code , a 30-minute feedback session was conducted which review ed office coordination , individual skill performance , and approach to resuscitation . Each participating practice also received an infant manikin and a text complete with several mock codes scenarios written specifically for the pediatric primary care office . Evaluation of the intervention consisted of 2 components . ( 1 ) Pre- and postintervention completion of a self-administered survey assessed participants ' comfort in emergency situations and confidence to perform specific life-saving skills , using an ordinal scale : 1 = " strongly agree " to 5 = " strongly disagree " . ( 2 ) Practice s were contacted by telephone 12 months after the training to determine whether they had implemented improvements in emergency preparedness , including instituting mock codes , preparing a written emergency protocol and purchasing new emergency equipment and medications . Results : Eleven group pediatric practice s participated , which were representative of urban , suburban , and rural offices in southwestern Pennsylvania . Ninety-seven of a total 164 ( 59 % ) physicians and staff members completed both pre- and postintervention surveys . Practitioner participants were analyzed in 2 groups . Group 1 consisted of physicians , nurse practitioners , and physician assistants ; group 2 consisted of registered nurses , licensed practical nurses , and medical assistants . Comparison of pre- versus postintervention surveys in both of these groups revealed significant improvement in reported confidence to perform resuscitation skills that were included in the mock code after the training : airway positioning ( group 1 , 67 % vs. 94 % , P < 0.001 ; group 2 , 55 % vs. 75 % , P = 0.003 ) , airway suctioning , ( group 1 , 64 % vs. 88 % , P = 0.005 ; group 2 , 27 % vs. 51 % , P < 0.001 ) , and bag-mask assisted ventilation ( group 1 , 82 % vs. 91 % , P = 0.003 ; group 2 , 39 % vs. 71 % , P < 0.001 ) . In addition , group 1 reported more confidence in their ability to place an intraossesous line ( 24 % vs. 39 % , P = 0.003 ) and group 2 showed a significant increase in their confidence to administer oxygen  ( 65 % vs. 84 % , P < 0.001 ) . As a result of the mock code , 83 % of all participants , both medical and nonmedical staffs , and 96 % of physicians felt less anxious about medical emergencies in the office . Twelve months after the conclusion of the program , 18 % of offices had conducted 1 or more mock codes , 64 % of offices had written an emergency protocol , and 27 % of offices had acquired essential resuscitation medications or equipment . Conclusions : The results of this study support the recommendation that mock codes should be performed in the pediatric primary care setting to improve practitioner confidence and decrease practitioner anxiety Background Benefits of skills lab training are widely accepted , but there is sparse research on its long-term effectiveness . We therefore conducted a prospect i ve , r and omised controlled-trial to investigate whether in a simulated setting students trained according to a  " best practice " model ( BPSL ) perform two skills of different complexity ( nasogastral tube insertion , NGT ; intravenous cannulation , IVC ) better than students trained with a traditional " see one , do one " teaching approach ( TRAD ) , at follow-up of 3 or 6 months . Methodology and Principal Findings 94 first-year medical students were r and omly assigned to one of four groups : BPSL training or TRAD teaching with follow-up at 3 ( 3 M ) or 6 ( 6 M ) months . BPSL included structured feedback , practice on manikins , and Peyton ’s " Four-Step-Approach " , while TRAD was only based on the " see one - do one " principle . At follow-up , manikins were used to assess students ’ performance by two independent blinded video-assessors using binary checklists and a single-item global assessment scale .  BPSL students scored significantly higher immediately after training ( NGT : BPSL3 M 94.8%±0.2 and BPSL6 M 95.4%±0.3 percentage of maximal score ± SEM ; TRAD3 M 86.1%±0.5 and TRAD6 M 84.7%±0.4 . IVC : BPSL3 M 86.4%±0.5 and BPSL6 M 88.0%±0.5 ; TRAD3 M 73.2%±0.7 and TRAD6 M 72.5%±0.7 ) and lost significantly less of their performance ability at each follow-up ( NGT : BPSL3 M 86.3%±0.3 and TRAD3 M 70.3%±0.6 ; BPSL6 M 89.0%±0.3 and TRAD6 M 65.4%±0.6 ; IVC : BPSL3 M 79.5%±0.5 and TRAD3 M 56.5%±0.5 ; BPSL6 M 73.2%±0.4 and TRAD6 M 51.5%±0.8 ) . In addition , BPSL students were more often rated clinical ly competent at all assessment times . The superiority at assessment after training was higher for the more complex skill ( IVC ) , whereas NGT with its lower complexity profited more with regard to long-term retention . Conclusions This study shows that within a simulated setting BPSL is significantly more effective than TRAD for skills of different complexity assessed immediately after training and at follow-up . The advantages of BPSL training are seen especially in long-term retention BACKGROUND AND OBJECTIVE : Simulation-based medical education ( SBME ) is used to teach residents . However , few studies have evaluated its clinical impact . The goal of this study was to evaluate the impact of an SBME session on pediatric interns ’ clinical procedural success . METHODS : This r and omized trial was conducted at 10 academic medical centers . Interns were surveyed on  infant lumbar puncture ( ILP ) and child intravenous line placement ( CIV ) knowledge and watched audiovisual expert modeling of both procedures .  Participants were r and omized to SBME mastery learning for ILP or CIV and for 6 succeeding months reported clinical performance for both procedures . ILP success was defined as obtaining a sample on the first attempt with < 1000 red blood cells per high-power field or fluid described as clear . CIV success was defined as placement of a functioning catheter on the first try . Each group served as the control group for the procedure for which they did not receive the intervention . RESULTS : Two-hundred interns participated ( 104 in the ILP group and 96 in the CIV group ) . Together , they reported 409 procedures . ILP success rates were 34 % ( 31 of 91 ) for interns who received ILP mastery learning and 34 % ( 25 of 73 ) for controls ( difference : 0.2 % [ 95 % confidence interval : –0.1 to 0.1 ] ) . The CIV success rate was 54 % ( 62 of 115 ) for interns who received CIV mastery learning compared with 50 % ( 58 of 115 ) for controls ( difference : 3 % [ 95 % confidence interval : –10 to 17 ] ) . CONCLUSIONS : Participation in a single SBME mastery learning session was insufficient to affect pediatric interns ’ subsequent procedural success OBJECTIVE To evaluate the effectiveness of an educational intervention on pediatric residents ' resuscitation fund of knowledge , technical skills , confidence , and overall performance . DESIGN Prospect i ve , nonconcurrent , controlled interventional trial . SETTING Urban pediatric tertiary care hospital . PARTICIPANTS An intervention group ( IG ) of 28 pediatric residents graduating in 1997 , and a control group ( CG ) of 30 pediatric residents graduating in 1996 . INTERVENTIONS Resuscitation course with didactic lectures and skills practice stations , as well as a minimum of 3 practice mock resuscitations with immediate feedback throughout postgraduate year 3 . MAIN OUTCOME MEASURES Fund of knowledge , using the Pediatric Advanced Life Support test and short answer test ; technical skills , using the Airway and Vascular Access Skills Assessment ; experience and confidence , using an anonymous survey ; and overall performance , evaluated using a videotaped mock resuscitation test . RESULTS The IG scored better on the short answer test ( P<.001 ) . A larger number of IG residents were successful in the completion of ancillary airway maneuvers and femoral vascular access ( P = .02 ) , as well as endotracheal intubation ( P = .004 ) and intraosseous access ( P = .002 ) . The IG was more confident in their leadership role ( P = .0001 ) and technical skills ( P = .05 ) . Trends toward improved overall performance were noted for the IG mock resuscitations . Residents in the IG were more likely to assess the airway in fewer than 2 minutes ( P = .02 ) , recognize the threat to life in fewer than 5 minutes ( P = .02 ) , and complete the primary survey in a timely fashion ( P = .05 ) . They required fewer prompts ( P = .04 ) and made fewer mistakes ( P = .07 ) . CONCLUSIONS A structured , formal curriculum can improve the necessary fund of knowledge , skills , confidence , and leadership required for resuscitation Background Unsuccessful or traumatic lumbar punctures ( LPs ) occur commonly and contribute to patient discomfort and to challenges in medical decision making in the pediatric emergency department ( ED ) . Objective We produced an instructional video demonstrating the best practice s in pediatric LP technique . We hypothesized that the performance of LPs would change and the rate of successful LPs would increase after watching the video . Methods This was a prospect i ve study of LPs performed in an urban , academic pediatric ED before and after an educational intervention . Lumbar punctures performed during year 1 constituted the control arm . During year 2 , all medical practitioners working in the ED watched the instructional video , and this constituted the interventional arm . The practitioner performing the LP completed a st and ardized data collection form after each LP procedure , and medical records were review ed . Results Data forms were collected on 668 LPs during the study period , 391 during year 1 and 277 during year 2 . There was neither a significant change in overall LP success rate between the 2 years ( 56.8 % year 1 vs 53.4 % year 2 ) nor a significant difference in median number of LP attempts required per patient ( P = 0.78 ) . Seventy-eight percent of participants who viewed the LP video during year 2 stated that the video helped increase their comfort level with performing LPs . The odds of using the techniques endorsed in the educational video were significantly higher during year 2 compared to year 1 for use of local anesthetic , early stylet removal , and vertical patient position . Conclusions The video increased practitioners ’ comfort level with the performance of pediatric LPs and adherence to evidence -based best practice s. It was not associated with an increased rate of successful LPs 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 ,  
    Output:
    
Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures , and these approaches should be the mainstay of programmes that train physicians to perform procedures .