***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 : Current guidelines recommend cervical spine immobilization during orotracheal intubation  when traumatic injury is suspected in infants . We evaluated the effect of cervical spine immobilization techniques on  orotracheal intubation performance with a high-fidelity infant simulator . Methods : A r and omized control study with repeated measurement . Nonanesthesia pediatric practitioners certified for intubation performed 6 intubations  with 3 different cervical spine immobilization techniques ( no physical protection , manual in-line immobilization , and cervical collar : C-collar ) . Time to accomplish key actions , cervical extension angle , and observed intubation associated events such as mainstem intubation , esophageal intubation with or without immediate recognition were recorded . Results : Twenty-six practitioners performed 156 successful orotracheal intubation .  Time to intubation from end of mask assist ventilation was 29.0 ± 12.2 seconds in no physical protection , 33.0 ± 17.4 seconds in C-collar , and 33.0 ± 17.1 seconds in manual in-line immobilization ( P = 0.39 ) . Maximal cervical extension angle in no physical protection ( 2.39 ± 2.56 ° ) and C-collar ( 2.65 ± 1.79 ° ) were significantly greater compared with 0.85 ± 1.05 ° in manual in-line immobilization ( P < 0.0001 ) . The number of intubation attempts and intubation associated events were not different among 3 techniques . Laryngeal visualization measured by Cormack-LehaneScale was more difficult in C-collar compared with other 2 techniques ( P < 0.001 ) . Conclusions : In this high-fidelity infant simulator model , cervical spine immobilization technique affected cervical extension angle and laryngeal visualization . Tracheal intubation associated events occurred in 33 % of intubation attempts but were not different by technique . Time to achieve tracheal intubation , number of intubation attempts needed to succeed , and intubation-associated events were not affected by immobilization techniques . These results support Advanced Trauma Life Support recommendations to perform manual in-line immobilization in infants Background : Part task training ( PTT ) focuses on dividing complex tasks into components followed by intensive concentrated training on individual components . Variable priority training ( VPT ) focuses on optimal distribution of attention when performing multiple tasks simultaneously with the goal of flexible allocation of attention . This study explored how principles of PTT and VPT adapted to anesthesia training would improve first-year anesthesiology residents ' management of simulated adverse airway and respiratory events . The authors hypothesized that participants with PTT and VPT  would perform better than those with st and ard training . Methods : Twenty-two first-year anesthesia residents were r and omly divided into two groups and trained over 12 months . The control group received st and ard didactic and simulation-based training . The experimental group received similar training but with emphasis on PTT and VPT techniques . Participant ability to manage seven adverse airway and respiratory events were assessed before and after the training period . Performance was measured by the number of correct tasks , making a correct diagnosis , assessment of perceived workload , and an assessment of scenario comprehension . Results : Participants in both groups exhibited significant improvement in all metrics after a year of training . Participants in the experimental group were able to complete more tasks and answered more comprehension questions correctly . There was no difference in perceived workload or the number of correct diagnoses between groups . Conclusion : This study in part confirmed the study hypotheses . The results suggest that VPT and PTT are promising adjuncts to didactic and simulation-based training for management of adverse airway and respiratory events This prospect i ve study on a medium‐fidelity simulator ( SimMan ® , Laerdal Medical Corporation , Wappingers Falls , NY , USA ) examined the management of unanticipated difficult airway by 21 anaesthetists and the effect of training in this context . There were two scenarios investigated : ‘ can not intubate , can ventilate’(CI ) and ‘ can not intubate , can not ventilate’(CICV ) . Following initial evaluation , volunteers underwent training in the ‘ Difficult Airway Society ’ ( DAS ) algorithms and associated technical skills . At 6–8 weeks and 6–8 months , performance was compared with the initial evaluation . There was a more structured approach following training ( p < 0.05 ) , which was sustained at 6–8 months , but only for the CICV scenario ( p < 0.01 ) . In CI , use of st and ard and intubating laryngeal mask airway increased following training ( p = 0.021 ) . This was sustained over time ( p = 0.01 ) . In both scenarios there was a reduced incidence of equipment misuse ( p < 0.0005 ) , which was sustained over time ( p < 0.0001 ) . We conclude that simulation‐based training  significantly improves performance for at least 6–8 weeks . Training should be repeated at intervals of 6 months or less PURPOSE To evaluate the effectiveness of the Actronics Interactive Learning System to teach the psychomotor skills of advanced airway management compared to the traditional method of lecture/demonstration . METHODS The study was a nonr and omized , nonequivalent comparison group design of a convenience sample of 86 American Heart Association ( AHA ) , advanced cardiac life support ( ACLS ) students , who obtained instruction in airway management by the interactive videodisc ( IVD ) learning system ( n = 41 ) , or by the traditional method of demonstration/return demonstration ( n = 45 ) . The evaluation criteria for the students were based on the number of attempts required to perform successfully endotracheal ( ET ) intubation and esophageal obturator airway ( EOA ) insertion . RESULTS No statistically significant differences in the performance of ET insertion between the IVD and the traditional method of instruction could be demonstrated . However , initial certifiers for ACLS learning EOA insertion by the IVD method had a treatment effect ( p = 0.004 ) compared to ACLS students learning by the traditional method . This treatment effect was not noted with ET intubation and EOA insertion for students seeking recertification . In a post-test satisfaction question naire , 34 IVD students reported satisfaction with learning airway management using this instructional method , but also expressed a preference to have an ACLS instructor available . CONCLUSION This study highlights the role of IVD in teaching the complex skills of advanced airway management Purpose : Simulation centres , where trainees can practise technical procedures on models of varying fidelity , provide a training option that allows them to acquire skills in a controlled environment prior to clinical performance . It has been proposed that the time to complete a simulator task may translate to proficiency in the clinical setting . The objective of this study was to determine whether time to complete a simulator task translates to clinical fibreoptic manipulation ( FOM ) performance . Methods : Thirty registered respiratory therapists at a teaching hospital were recruited as subjects for a single-blinded r and omized trial . Subjects were r and omized to training on either a low fidelity ( n=15 ) or high fidelity ( n=15 ) model . After training , each subject was tested for the time required to complete a specific task on his/her respective model . Subjects then performed a fibreoptic orotracheal intubation ( FOI ) on healthy , consenting , and anesthetised patients requiring intubation for elective surgery . Performance was measured independently by blinded examiners using a checklist and global rating scale ( GRS ) ; and time was measured from insertion of the fibreoptic scope to visualization of the carina . Data were analyzed using Spearman rank order correlation coefficients . Results : There was no correlation between the time to complete a task on either the high or low fidelity simulators , and the clinical FOI performance as assessed by a checklist , GRS , and time to complete the FOM ( allP = NS ) . Conclusion : These results suggest that simulator-based , task-orientated time measurement may not be a good indicator of FOI performance in the clinical setting .RésuméObjectif : Les centres de simulation , où les stagiaires peuvent s’exercer à réaliser des gestes techniques sur des modèles d’une fidélité variable , constituent une alternative de formation qui leur permet d’acquérir des compétences dans un environnement contrôlé et ce , avant de travailler dans un environnement clinique . Il a été suggéré que le temps nécessaire à compléter une tâche dans un simulateur pourrait refléter l’aptitude dans un context e clinique . L’objectif de cette étude était de déterminer si le temps utilisé pour compléter une tâche dans un simulateur se traduisait en performance de manipulation fibroscopique ( FOM ) clinique . Méthode : Trente inhalothérapeutes certifiés oeuvrant dans un hôpital universitaire ont été recrutés pour participer à cette étude r and omisée en simple aveugle . Les sujets ont été r and omisés à s’entraîner soit avec un modèle peu fidèle ( n=15 ) ou très fidèle ( n=15 ) . Après la formation , chaque sujet a été testé par rapport au temps requis pour compléter une tâche spécifique sur son modèle respectif . Les sujets ont ensuite réalisé une  intubation orotrachéale par fibroscopie ( FOI ) sur des patients sains , consen-tants et anesthésiés nécessitant une intubation pour une chirurgie élective . La performance a été mesurée de façon indépendante par des examinateurs en aveugle à l’aide d’une liste de contrôle et une échelle d’évaluation générale ( GRS ) ; le laps de temps écoulé entre l’insertion du fibroscope et la visualisation de la carène a été mesuré . Les données ont été analysées à l’aide des coefficients de corrélation des rangs de Spearman . Résultats : Il n’y a pas eu de corrélation entre le temps nécessaire à compléter une tâche sur les simulateurs , qu’ils soient très fidèles ou peu fidèles , et la performance d’intubation par fibroscopie telle que mesurée par une liste de contrôle , le GRS , et le temps pour effectuer la FOM ( tous P = NS ) . Conclusion : Ces résultats suggèrent que le chronométrage basé sur simulateur et centré sur la tâche ne constitue pas un bon indice de la performance de FOI dans un context e clinique The GlideScope ® is a new video laryngoscope developed for management of the difficult airway . We compared the GlideScope with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy . Twenty anaesthetists were allowed three attempts to intubate in each of four laryngoscopy scenarios in a high fidelity simulator . In the simulated easy laryngoscopy scenarios , the anaesthetists took longer to intubate using the GlideScope than the Macintosh laryngoscope ( mean ( SD ) 19.0 ( 9.7 ) s vs. 12.7 ( 5.9 ) s , respectively ; p = 0.006 ) . There was no difference in the number of successful intubations , ease of intubation or choice of intubating device . In the simulated difficult laryngoscopy scenarios , the anaesthetists took less time to intubate using the GlideScope ( 23.5 ( 12.7 ) s vs. 70.5 ( 101.2 ) s , respectively ; p = 0.001 ) . The slightly higher success rate with the GlideScope was not statistically significant ( 20/20 vs. 18/20 , respectively ; p = 0.5 ) . However , the anaesthetists found it easier to intubate using the GlideScope ( median ( interquartile range [ range ] ) 1 ( 1–2 [ 1–2 ] ) vs. 2 ( 2–3 [ 1–3 ] ) , respectively ; p < 0.0001 ) STUDY OBJECTIVE To show that a complex motor skill can be taught without requiring active expert faculty participation . DESIGN Prospect i ve descriptive study . SETTING Simulation laboratory of an academic anesthesiology department . SUBJECTS Novice users of the Bullard laryngoscope , predominantly residents . INTERVENTIONS Novice Bullard users were presented with a PowerPoint presentation using text and pictures describing the use of the Bullard . The learners were also provided with a Bullard laryngoscope and a mannequin on which to practice .  Self-learning time was not restricted . MEASUREMENTS Learners decided for themselves when they were competent and ready for competency assessment . The assessment tool was a checklist of essential steps developed by faculty experienced in Bullard laryngoscopy . The primary end-point was successful intubation . MAIN RESULTS All learners were deemed competent . The mean self-learning time was 14.1 minutes ( SD , 3.1 min ; range , 9.2 - 21.0 min ) . All subjects indicated a high level of satisfaction with the learning technique . CONCLUSIONS Teaching a complex motor skill with no expert instruction is possible Objectives : Patient simulation is emerging as a training technique in the field of medicine . It has particular application in training responses to high-risk , low-frequency clinical events , of which a typical example is in-hospital cardiac arrest . A critical element of response by the cardiac arrest team is initial airway management . In teaching hospitals , medical interns are first responders to in-hospital cardiac arrests . Our objective was to design and test a program using a computer-controlled patient simulator to train medical interns and demonstrate their competence in initial airway management . Design : Prospect i ve , r and omized , controlled , unblinded trial . Setting : Internal medicine residency training program in an urban teaching hospital . Participants : All 50 starting internal medicine interns in July 2002 , all Advanced Cardiac Life Support certified in June 2002 . Interventions : All interns were tested in initial airway management skills and then were r and omly assigned to receive either immediate or delayed individual 
    Output:
    
Few studies have analyzed the effects of this modality on trainer skills and patient safety .