***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: This study evaluated the effects of brief monthly refresher training on CPR skill retention , confidence , and satisfaction with CPR skill level of 606 nursing students from ten different US schools . Students were r and omized to course type , HeartCode ™ Basic Life Support ( BLS ) or an  instructor-led ( IL ) course , and then r and omized to a practice group , six minutes of monthly practice or no further practice . End-of- study survey results were compiled and reported as percentages . Short answer data were grouped by category for reporting . Fewer HeartCode ™ BLS students were satisfied with their CPR training compared to the IL students . Students who practice d CPR monthly were more confident than students who did not practice . Monthly practice improved CPR confidence , but initial course type did not . Students were most satisfied when they participated in the IL courses and frequent practice of CPR skills BACKGROUND The use of simulation to reproduce the experience of health care setting s and its use as a strategy in the teaching of nurses has grown at an unprecedented rate . There is little scientific evidence to examine the differences in satisfaction and gains perceived by the students with the use of medium and high fidelity . OBJECTIVES To analyse and benchmark gains and satisfaction perceived by nursing students , according to their participation in medium- and high-fidelity simulated practice . DESIGN R and omized control trial post-test only design with control group . SETTING AND PARTICIPANTS Students of the 4th year of the Bachelor 's Degree in Nursing who performed medium and high-fidelity simulated practice in a Simulation Centre environment .  METHODS A satisfaction scale and a scale of perceived gains from the simulation  were applied to the students who underwent simulated practice in a medium-fidelity environment ( control group ) and high-fidelity environment ( experimental group ) . Statistical analysis was performed and a significance level of p<0.05 was established . RESULTS Of the 85 students who participated in the study , the majority were female ( 92.94 % ) , with an average age of 21.89years ( SD=2.81years ) .  Satisfaction is statistically significant in the realism dimension and overall satisfaction . In the gains perceived with the simulation there is a statistically significant difference in the dimension recognition/decision . CONCLUSION Students are very satisfied with the realism of high-fidelity simulated practice and consider that this helps them more with recognition and decision compared with the medium-fidelity simulation INTRODUCTION One of the newest teaching modalities in health education is the use of human patient simulators ( HPS ) . A simulation scenario creates a software program vignette in which nursing , medical , and other students interact with a manikin to practice caring for patients in a risk-free environment . Although used extensively in schools of nursing , there is little research that examines if these expensive simulators improve the clinical decision-making ability of nursing students . The purpose of this quasi-experimental differentiated treatment study was to assess if HPS technology leads to greater clinical decision-making ability and clinical performance compared to the teaching modality of a paper and pencil case study . METHODS Students ( n = 133 ) learning about the care of a patient with a myocardial infa rct ion at four licensed practical nursing programs ( LPN ) in Pennysylvania , USA were r and omly assigned to one of two groups at each site : an HPS simulation group or a paper and pencil case study group . One-tailed , independent t-tests were used to compare learning gains measured by differences in pre- and post clinical decision-making exam scores and clinical performance . RESULTS Results indicated that students in the simulation groups were significantly more likely to score higher on the clinical decision-making exams and to respond clinical ly by performing CPR more quickly on the manikin than students in the case study groups . On the 100-point exam , the simulation groups had a 20-point gain , while the case study groups had a 12-point gain ( P < 0.001 ) . Students in the simulation groups provided CPR to a manikin 30 seconds faster , on an average ( P < 0.001 ) . DISCUSSION Results vali date the use of HPS technology in nursing education . Ultimately patients may benefit from increased knowledge and speed of care from practical nurses whose training was improved through the use of HPS technology BACKGROUND Clinical simulations can provide students with realistic clinical learning environments to increase their knowledge , self-confidence , and decrease their anxiety prior to entering clinical practice setting s. OBJECTIVE To compare the effectiveness of two  maternal newborn clinical simulation scenarios ; virtual clinical simulation and face-to-face high fidelity manikin simulation . DESIGN R and omized pretest-posttest design . SETTING A public research university in Canada . PARTICIPANTS Fifty-six third year Bachelor of Science in Nursing students . METHODS Participants were r and omized to either face-to-face or virtual clinical simulation and then to dyads for completion of two clinical simulations . Measures included : ( 1 ) Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale ( NASC-CDM ) ( White , 2011 ) , ( 2 ) knowledge pretest and post-test related to preeclampsia and group B strep , and ( 3 ) Simulation Completion Question naire . Before and after each simulation students completed a knowledge test and the NASC-CDM and the Simulation Completion Question naire at study completion . RESULTS There were no statistically significant differences in student knowledge and self-confidence between face-to-face and virtual clinical simulations .  Anxiety scores were higher for students in the virtual clinical simulation than for those in the face-to-face simulation . Students ' self-reported preference was face-to-face citing the similarities to practicing in a ' real ' situation and the immediate debrief . Students not liking the virtual clinical simulation most often cited technological issues as their rationale . CONCLUSIONS Given the equivalency of knowledge and self-confidence when undergraduate nursing students participate in either maternal newborn clinical scenarios of face-to-face or virtual clinical simulation identified in this trial , it is important to take into the consideration costs and benefits /risks of simulation implementation BACKGROUND There is a gap in the literature regarding learning outcomes linked to the use of high-fidelity simulators compared to that of traditional teaching methods . AIM To examine the effect of using high-fidelity simulators on knowledge and skills acquisition and retention with university students . METHODS A r and omized two-arm trial using two different educational approaches on 90 nursing students assigned r and omly to two groups was used at two points of time . FINDINGS The results showed significant differences in favor of the participants in the high-fidelity simulator group on both the acquisition and retention of knowledge and skills over time . However , a significant loss of cardiopulmonary resuscitation knowledge and skills occurred at 3 months after training in both groups . CONCLUSIONS The findings of this study may assist educators in integrating high-fidelity simulators in education and training . In addition , the findings may help nursing educators to arrange additional cardiopulmonary resuscitation training sessions in order to improve cardiac arrested patients ' outcomes . LINKING EVIDENCE TO ACTION High-fidelity simulation ( HFS ) provides students with interactive learning experiences in a safe controlled environment . HFS enables teachers to implement critical clinical scenarios , such as cardiac arrest , without risk to patients . Integrating the simulation training into nursing curricula will help to overcome the challenges that face many courses , specifically the shortage of clinical areas for training and the increase in numbers of nursing students PURPOSE To investigate occupational exposures to biological material potentially infected by blood-borne viruses in nursing student population during the course years . DESIGN AND METHODS An observational retrospective study was design ed . Data were collected in May 2007 . Two-thous and -two-hundred-fifteen nursing students from the 3 years of degree course were enrolled in the four Italian universities . A structured question naire was constructed and was given out unannounced to nursing students in four universities on a r and omly chosen day . The likelihood of association between nursing student exposure and certain assumed risk factors was measured . FINDINGS The exposure risk is associated with each study year of nursing students . Specifically , the probability of accidental exposure is reduced significantly with the increase of clinical skills during the training period . The risk for exposure in the 1st year students appears significantly higher than in those of the next years ( odds ratio [ OR ] 1.465 ; 95 % confidence interval [ CI ] 1.105 - 1.943 ) . Data highlighted a gradual increase of bio-safety knowledge in nursing students from the 1st to the 3rd years of study . However , a statistically significant association exists only between awareness of a correct use of gloves and exposure risk ( OR 0.435 ; 95%CI 0.227 - 0.834 ) . Mucocutaneous exposures are more frequent than percutaneous exposures ( 62.2 % ) , and the hollow-bore needle is the device most often involved . In 42.5 % of cases , accidental exposures occurred when nursing students are working alone in a medical ward or surgery area . CONCLUSIONS During their clinical training , nursing students can encounter a real risk for percutaneous and mucocutaneous exposures to blood potentially infected with blood-borne viruses . However , this risk is reduced with an increase in clinical skills . CLINICAL RELEVANCE Results show that some new strategies are necessary for exposure risk reduction such as development of simulation laboratories for nursing practice and the adequate presence of tutors in clinical training education Epidemiological evidence about the accuracy of diagnostic tests , the power of prognostic markers , and the efficacy and safety of interventions is the cornerstone of evidence -based health care.1 Practitioners of evidence -based health care require critical appraisal skills to judge the validity of this evidence . The Evidence -Based Medicine ( EBM ) Working Group members are international leaders in teaching critical appraisal skills , and their users ’ guides for appraising the validity of the healthcare literature 2 have long been the basis of teaching programmes worldwide . However , we found that many of our students took a reductionist “ paint by numbers ” approach when using the Working Group ’s guides . Students could answer individual appraisal questions correctly but would have difficulty assessing overall study quality . We believe this is due to a poor underst and ing of epidemiological study design . So over the past 15 years of teaching critical appraisal we have modified the EBM Working Group approach and developed the Graphic Appraisal Tool for Epidemiological studies ( GATE ) frame to help our students conceptualise the whole study as well as its component parts . GATE is a visual framework that illustrates the generic design of all epidemiological studies ( figure 1 ) . We now teach critical appraisal by “ hanging ” studies and the EBM Working Group ’s appraisal questions on the GATE frame . Figure 1 The GATE frame . This editorial outlines the GATE approach to critical appraisal , illustrated throughout using the Heart and Estrogen/progestin Replacement Study ( HERS ) , a r and omised , double blind , placebo controlled trial of the effect of daily oestrogen plus progestin on coronary heart disease ( CHD ) death in postmenopausal women.3 A detailed critical appraisal of HERS using a GATE-based checklist is available online.4 The GATE frame incorporates a triangle , circle , square , and arrow ( figure 1 ) , labelled with the acronym PECOT ( or PICOT ) . The triangle ( figure 2 ) represents the population studied : “ P ” for population or BACKGROUND An undergraduate nursing health assessment course provided three experiential modalities for practicing health assessment skills : high-fidelity human simulators ( HFS ) , st and ardized patients ( SP ) and community volunteers ( CV ) . Previous research has examined the impact of each distinct modality on learning outcomes . However , few studies have compared these learning strategies . This study investigates learners ' satisfaction , self-efficacy and performance behaviors among three learning approaches . METHOD Forty-four undergraduate nursing students were r and omly assigned to perform focused respiratory assessment s on a HFS , SP or CV . Participants completed the Health Assessment Educational Modality Evaluation ( HAEME ) survey to assess self-efficacy and modality satisfaction . A performance checklist evaluated assessment skills . RESULTS Performance behaviors were significantly greater with HFS , but learners were significantly less satisfied with this modality . Significant differences in students ' self-efficacy were not found across the three modalities . CONCLUSIONS Significantly lower satisfaction with HFS may reflect learners ' perceived lack of realism . However , HFS may provide a low-stress opportunity for novice learners to practice skills . Results support the integration of distinct experiential learning modalities in an undergraduate nursing health assessment course Patient simulation is increasingly used in the education of healthcare providers , yet few studies have compared simulation to other teaching modalities . The purpose of this study was to determine differences in knowledge acquisition and student satisfaction between two methods of teaching the principles of mechanical ventilation to advanced practice nursing ( APN ) students :  high-fidelity patient simulation ( including face-to-face instruction ) versus an online , narrated PowerPoint presentation .  Twenty APN students were r and omized to either the simulation or online teaching method in this pre/posttest study . Measures included a 12-item knowledge question naire and a 5-item satisfaction survey . Both groups had significant improvement in knowledge scores from pretest to posttest , but knowledge scores were not significantly different at posttest between groups . Student satisfaction with their learning method was significantly higher in the simulation group . Students choosing to participate in the alternative teaching method after study completion preferred the simulation to the online method Nursing actively engages various technologies to enhance education and training with increased learner confidence and patient safety . Simulation is a key technology to address the strain on the current nursing education system . The purpose of this study was to determine the effect of simulation-enhanced orientation on pediatric acute care examination scores and pediatric clinical course grade s among junior-level baccalaureate nursing students . No significant difference between groups ( p < 0.05 ) was detected for the students ' examination scores . Clinical grade s of the intervention group ( mean = 
    Output:
    
Compared with other teaching methods , HFPS revealed higher effects sizes on nursing students ' knowledge and performance .