***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: UNLABELLED Older people are trained infrequently in cardiopulmonary resuscitation ( CPR ) , yet are more likely to witness a cardiac arrest . Older people who are CPR trained perform CPR when witnessing a cardiac arrest . OBJECTIVE To assess whether elderly adults ( > 55 years ) who receive chest-compression only cardiopulmonary resuscitation ( CC-CPR ) training  display equivalent skill retention rates compared with those who receive traditional CPR instruction . We also identified factors associated with 3 months skill retention at 3 months in both groups . METHODS Older adults in a suburban hospital Older Adult Services program were invited to participate in an experimental CPR course . The 2 h course was modelled after the AHA Friends and Family course , and used one of two st and ardized video scenarios . Seventy four subjects were r and omized to CC-CPR ( n=36 ) or traditional CPR ( n=38 ) training . Participation consisted of initial training , followed by a 3 months return videotaped assessment . Three months skill competence was assessed either by consensus between two video evaluators , or the on-site evaluator . Chi square and Kappa tests were used for analysis , and unadjusted odds ratios and 95 % confidence intervals are reported . RESULTS Skill retention assessment s were completed on 29 ( 81 % ) CC-CPR and 26 ( 68 % ) CPR trainees . Subjects were elderly ( 71.5+/-6.69 years ) , and had a high rate of previous CPR training ( 58.0 % ) . Groups were similar in demographic characteristics . After training , participants exhibited high rates of perceived competence ( 86.4 % ) , although the overall 3 months skill retention was low ( 43.6 % ) . CC-CPR training result ed in equivalent skill retention rates as compared with traditional CPR training ( 51.7 vs. 44.4 % ; P=0.586 ) . No participant factors were associated with skill retention , including age , previous CPR training , education level , medical history , or perceived physical ability to perform . CONCLUSION We identified low rates of CPR skill retention in this elderly population . CC-CPR instruction was associated with equivalent skill retention rates compared with traditional CPR instruction . No demographic factors were associated with successful skill retention This r and omised controlled trial used a manikin model of cardiac arrest to compare skill performance in untrained lay persons r and omised to receive either compression-only telephone CPR ( Compression-only tel . , n=29 ) or st and ard telephone CPR instructions ( St and ard tel . , n=30 ) . Performance was evaluated during st and ardised 10 min cardiac arrest simulations using a video recording and data from a laptop computer connected to the training manikin . A number of subjects in both groups did not open the airway . More than 75 % in the St and ard tel . group failed to deliver two effective initial rescue breaths , and only 17 % provided an adequate inflation volume for subsequent breaths , delivering a median of only five inflations during the entire scenario . Most subjects in both groups gave chest compressions that were too shallow and at an inappropriately rapid rate . H and position was also poor , but was worse in the group given simplified instructions . There was a significant delay to first compression in both groups , although this interval was shortened by over a minute when ventilations were eliminated from the telephone instruction algorithm ( 245 vs. 184 s , P<0.001 ) . Over two- and -a-half times as many chest compressions were delivered during an average ambulance response time with compression-only telephone directions compared with st and ard CPR ( 461 vs. 186 , P<0.001 ) . These variables may be critical in predicting survival from out-of-hospital cardiac arrest . Further research is necessary to establish if modifications to scripted telephone instructions can remedy the identified performance deficiencies . Eliminating instructions for rescue breaths from scripted telephone directions will have little impact on the ventilation of most patients . Research is required to determine if the consequent reduction in the delay to starting chest compressions and the significant increase in the number of compressions delivered can increase survival from out-of-hospital cardiac arrest 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 OBJECTIVE To determine whether an advanced cardiac life support ( ACLS ) computer simulation program improves retention of ACLS guidelines more effectively than textbook review . DESIGN R and omized , controlled trial . SETTING Academic medical center . PARTICIPANTS Forty-five anesthesia residents and faculty tested 10 to 11 months after ACLS provider course training . INTERVENTION Participants were r and omized and asked to prepare for a mock resuscitation ( Mega Code ) with either textbooks or a computerized ACLS simulation program . MAIN OUTCOME MEASURE Performance on a st and ardized Mega Code examination that required application of supraventricular tachycardia , ventricular fibrillation , and second-degree Type II atrioventricular block algorithms . Mega Code sessions were administered by an instructor who was blinded as to the subject group . The sessions were videotaped and scored by two evaluators who also were blinded as to the subject group . RESULTS Participants who used the ACLS simulation program  scored significantly higher ( mean 34.9 + /- 5.0 [ SD ] of 47 possible points ) than participants who review ed using a textbook ( 29.2 + /- 4.9 ) ; p < .001 . Pass-fail rates for the algorithms were also higher for the group that review ed with the simulator ( mean 2.5 + /- 0.5 of 3 possible passes ) than the group that used the textbook ( 1.6 + /- 1.0 ) ; p = .001 . CONCLUSIONS Use of a computerized ACLS simulation program improves retention of ACLS guidelines better than textbook review This study compares the retention of basic life support ( BLS ) skills after 6 and 12 months by lay persons trained either in a conventional manner , or using a staged approach .  Three classes , each of 2h , were offered to volunteers over a period of 4 months . For the conventional group , the second and third classes consisted of review of skills . Those in the staged group were first taught chest compression alone ; chest compression with ventilation in a ratio of 50:5 was introduced at the second class ; full st and ard CPR was taught at the third class . A total of 495 volunteers entered the study , 262 being r and omly allocated to conventional training , and 233 to staged training .  More of those who received staged training attended a second ( 78 volunteers ) and third class ( 41 volunteers ) , compared with those who received conventional training ( 36 and 17 , respectively ) . The objective of this study , however , was to compare the strategies of the different training methods . A total of 291 volunteers ( 167 conventional and 124 staged training ) were available for unannounced home testing of full conventional CPR 6 months after initial training , and 260 volunteers ( 135 conventional and 125  staged training ) were tested at 12 months . At 6 months , those taught by the staged method were significantly better at time to first compression ( P < 0.0001 ) , compression rate ( P = 0.024 ) , and h and position ( P = 0.0001 ) . At 12 months , those taught by the staged method were significantly better at shouting for help ( P = 0.005 ) , time to first compression ( P < 0.0001 ) , and compression depth ( P = 0.003 ) . Those taught conventionally were significantly better at checking for a carotid pulse at both 6 and 12 months ( P < 0.0001 ) . These results suggest that training lay persons in basic life support skills using a staged approach leads to overall better skill retention at 6 and 12 months , and has other advantages including a greater willingness to re-attend follow-up classes BACKGROUND Survival improves in witnessed out-of-hospital cardiac arrest if the victim receives byst and er-initiated cardiopulmonary resuscitation and rapid defibrillation ( BLS/AED ) . The European Resuscitation Council has a simple programme to teach these life-saving skills that require no previous experience of automated external defibrillators ( AEDs ) . To be able to implement the use of AEDs widely , many instructors are needed , and therefore , lay persons may also be used as trainers . The purpose of this r and omized study was to compare lay volunteers trained by a lay person with those trained by a health care professional using the Objective Structured Clinical Examination ( OSCE ) . METHODS Eight instructors , including four lay persons and four health care professionals , were given a basic course and an instructor course in CPR-D by the same instructor . All newly trained instructors trained 38 lay volunteers ( 19 pairs ) who had no previous training in the use of a defibrillator .  The lay volunteers performed the OSCE 2 - 3 weeks after the course . The OSCE comprised two scenarios with a manikin : the first , a patient in cardiac arrest with ventricular fibrillation , and the second , an imminent cardiac arrest with asystole as the initial rhythm . The same OSCE was performed by a group of lay first aiders practicing every 2 weeks who served as the control group . RESULTS No statistical difference was present between the two groups of lay volunteers in the OSCE . All were able to use the AED and follow instructions . They identified patients with ventricular fibrillation and cardiac arrest , but had difficulties identifying cases with imminent cardiac arrest . The control group of trained first aiders performed significantly more effectively than the newly trained lay persons . CONCLUSIONS No significant benefit exists in the trainer being a health care professional , but thorough training and subsequent rehearsing of the skills learned are crucial INTRODUCTION There are no current vali date d scoring systems for the assessment of adult single rescuer basic life support ( BLS ) ability . A system was proposed and prospect ively vali date d. METHODS The system was tested firstly on 12 skilled BLS providers ( all instructors ) . It was then further evaluated on 75 undergraduate dental students , who were assessed before and after a st and ard training session on adult BLS .  RESULTS All 12 skilled persons passed the test according to the system . The system successfully showed a positive training effect in the dental students . It correctly identified those who ' passed ' after training , i.e. those were capable of providing effective BLS ( 71/75 , 94.7 % ) . It also correctly identified those who were not considered competent ( 4/71 , 5.3 % ) . CONCLUSION This is a simple , effective , objective system for assessment of basic life support . It is easily adaptable for the 1998 Guidelines on BLS We have investigated a method of teaching community CPR in three 
    Output:
    
Most studies in this review compared participants with each other , not against a st and ard or a defined passing level .