***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: & NA ; To increase cardiopulmonary arrest survival , the American Heart Association developed basic and advanced cardiac life support ( ACLS ) courses that expose participants to realistic learning situations . This experimental study compared results of two ACLS classes on measures of knowledge ( content exam ) and resuscitation skills ( performance exam ) .  Both the control and experimental groups consisted of physicians , nurses , emergency medical technicians , respiratory therapists , and advanced health care providers . The control group used low‐fidelity simulation ( LFS ) ; the experimental group was exposed to enhanced realism via high‐fidelity simulation ( HFS ) . The findings showed a positive correlation between enhanced practice and learning but no significant correlation between posttest and skills test scores for the LFS and HFS groups . The HFS group did score higher on both cognitive and behavioral tests , but the difference was not statistically significant . Participants from both groups indicated satisfaction with their forms of simulation experience and course design . In addition , participants ' self‐confidence to care for a victim of cardiopulmonary arrest was increased after completing their course ; profession and work experience had no effect on responses . The largest difference noted was in verbal responses to course satisfaction . The experimental group stated that learning using HFS was enjoyable and adamantly recommended that ACLS should only be taught using HFS . Further study is required to assess if practicing beyond the course enhances short‐ and long‐term retention of ACLS techniques Objectives : To assess the effect of high-fidelity simulation ( SIM ) on cognitive performance after a training session involving several mock resuscitations design ed to teach and reinforce Pediatric Advanced Life Support ( PALS ) algorithms . Methods : Pediatric residents were r and omized to high-fidelity simulation ( SIM ) or st and ard mannequin ( MAN ) groups . Each subject completed 3 study phases : ( 1 ) mock code exercises ( asystole , tachydysrhythmia , respiratory arrest , and shock ) to assess baseline performance ( PRE phase ) , ( 2 ) a didactic session review ing PALS algorithms , and ( 3 ) repeated mock code exercises requiring identical cognitive skills in a different clinical context to assess change in performance ( POST phase ) . SIM subjects completed all 3 phases using a high-fidelity simulator ( SimBaby , Laerdal Medical , Stavanger , Norway ) , and MAN subjects used SimBaby without simulated physical findings ( ie , as a st and ard mannequin ) . Performance in PRE and POST was measured by a scoring instrument design ed to measure cognitive performance ; scores were scaled to a range of 0 to 100 points . Improvement in performance from PRE to POST phases was evaluated by mixed modeling using a r and om intercept to account for within-subject variability . Results : Fifty-one subjects ( SIM , 25 ; MAN , 26 ) completed all phases . The PRE performance was similar between groups . Both groups demonstrated improvement in POST performance . The improvement in scores between PRE and POST phases was significantly better in the SIM group ( mean [ SD ] , 11.1 [ 4.8 ] vs. 4.8 [ 1.7 ] , P = 0.007 ) . Conclusions : The use of high-fidelity simulation in a PALS training session result ed in improved cognitive performance by pediatric house staff . Future studies should address skill and knowledge decays and team dynamics , and clearly defined and reproducible outcome measures should be sought OBJECTIVE To assess the educational efficacy of a Web-based pediatric advanced life support course ( Web-PALS ) . DESIGN Nonr and omized , prospect i ve , cohort study . SETTING University medical center . PARTICIPANTS Health care providers ( includes physicians , nurses , paramedics , and respiratory therapists ) taking either the Web-PALS or a traditional PALS course ( Trad-PALS ) .  MAIN EXPOSURE Web-PALS . MAIN OUTCOME MEASURES Postcourse written examination scores and scored videotapes of students performing 5 PALS procedures were compared between study groups . Students completed precourse and postcourse question naires , rating on a 5-point Likert scale their self-confidence to perform PALS assessment s and procedures . A structured , course satisfaction survey was given after students had taken the Web-PALS course . RESULTS Eighty-six students completed the study ( 44 Web-PALS and 42 Trad-PALS ) . All students achieved a passing score on the written examination on their first attempt . Compared with students in the Trad-PALS group , students in the Web-PALS group scored slightly lower ( 97.1 % vs 95.4 % ; difference , 1.7 % ; 95 % confidence interval , 0.1 - 3.2 ) . Mean overall videotape scores were similar among the Web-PALS and Trad-PALS groups ( 75.0 % vs 73.0 % ; difference , 2.0 % ; 95 % confidence interval , -2.0 to 6.0 ) . After completing the Web-PALS course , the mean level of confidence improved from 3.77 to 4.28 ( difference , 0.51 ; 95 % confidence interval , 0.33 - 0.69 ) . Ninety-six percent of respondents indicated that Web-PALS met all of the stated objectives of the PALS course . All respondents indicated that they would recommend Web-PALS to a colleague . CONCLUSIONS Students perceive Web-PALS as a positive educational experience . Though not identical to students taking the Trad-PALS course , they performed well on postcourse cognitive and psychomotor testing . These findings support Web-PALS as an acceptable format for administering the PALS course Objective This feasibility study aim ed to describe and evaluate the effectiveness of a novel chest re-opening paediatric resuscitation scenario training scheme . Methods A novel scheme offering training on specialist skills required for post-operative cardiac patients such as chest re-opening and cardiac pacing via simulation was described . A prospect i ve audit of the first 23 consecutive training sessions was conducted to assess the scheme ’s effectiveness . Parameters assessed included timing of chest re-opening or cardiac pacing orders , and any delays in carrying out these orders . Results The median time required for the medical team leader to order chest re-opening was 4 min . New medical leaders took significantly longer to order chest re-opening than experienced medical team leaders ( P = 0.02 , Mann – Whitney U test ) . The performance of the team-in-training deteriorated with the introduction of new members but was correctable with serial training . Conclusions Effective simulation training integrating chest re-opening and cardiac pacing into st and ard paediatric resuscitation guidelines may be achieved without high fidelity simulation equipment One hundred thirty-two physicians who successfully completed advanced cardiac life support ( ACLS ) training were r and omly placed in a control group or one of two groups receiving interventions design ed to provide reinforcement of previously mastered knowledge and skills . These interventions included mailed periodic reprints ( group 1 ) or quarterly patient management problems ( group 2 ) . All physicians were retested for knowledge and skills related to ACLS one year later . Fifty-two ( 39.4 % ) could successfully ventilate the mannequin , and 62 ( 47.0 % ) could perform cardiac compression adequately . No differences were noted among groups . Significant differences in knowledge were found . The control group initiated appropriate therapy in a mock-arrest situation 52 % of the time , while group 1 averaged 75 % and group 2 averaged 82 % . These results indicate that reinforcement after continuing medical education may enhance knowledge retention , but does not maintain motor skills . Yearly recertification in ACLS skills should be considered , and frequent practice sessions should be encouraged for those physicians who are not active participants in ACLS activities INTRODUCTION The CAREvent Public Access Resuscitator ( PAR , O-Two Medical Technologies , Ontario , Canada ) is a new oxygen-driven device alternating two ventilations with 15 prompts for chest compressions . The PAR is design ed for use with a st and ard resuscitation face mask and is equipped with mask leakage and obstruction alarms . The purpose of this study was to assess the quality of basic life support ( BLS ) by hospital nurses and to evaluate if BLS with the PAR is better than BLS using the mouth-to-mask technique . METHODS The study group consisted of 352 nurses from Ghent University Hospital working outside the critical care and emergency departments .  BLS skills were measured using a Laerdal Skillreporter manikin ( Laerdal , Norway ) connected to a Laerdal PC Skillreporting system . To assess base line skills , 200 nurses were tested without previous notice in single rescuer BLS using a pocket mask ( PM , Laerdal , Norway ) or a bag-valve mask device ( Laerdal , Norway ) over a period of 2 min . A separate consecutive sample of 152 nurses was r and omised to the PM or PAR groups after a st and ard BLS refresher course . The PAR group received a short period of training in PAR use . Immediately after training , both groups performed the 2 min  single rescuer BLS test . RESULTS Unprepared nurses achieved only 26 compressions and 3 ventilations/min . Immediately after training , nurses using the PAR delivered 54 compressions/min as opposed to 35 for the PM group ( p<0.0001 ) . PAR users ventilated six times/min compared to five times for PM users ( p<0.0001 ) . CONCLUSION Immediately after training , the use of the PAR  improved BLS performance by ward nurses significantly , bringing the number of ventilations and compressions per minute close to the theoretical maximum achievable within the current guidelines . Retention tests after 6 and 12 months will show if the effect is sustained Problem : Advance cardiac life support ( ACLS ) training does not address coordination of team re sources to improve the ability of teams to deliver needed treatments reliably and rapidly . Our objective was to use a human simulation training educational environment to develop multidisciplinary team skills and improve medical emergency team ( MET ) performance . We report findings of a crisis team training course that is focused on organization . Setting : Large center for human simulation training at a university affiliated tertiary care hospital . Participants : Ten courses were delivered and 138 clinical ly experienced individuals were trained ( 69 critical care nurses , 48 physicians , and 21 respiratory therapists ) . All participants were ACLS trained and experienced in responding to cardiac arrest situations . Course design : Each course had four components : ( 1 ) a web based presentation and pretest before the course ; ( 2 ) a brief reinforcing didactic session on the day of the course ; ( 3 ) three of five different simulated scenarios ; each followed by ( 4 ) debriefing and analysis with the team . Three of five simulator scenarios were used ; scenario selection and order was r and om . Trainees did not repeat any scenario or role during the training . Participants were video recorded to assist debriefing . Debriefing focused on reinforcing organizational aspects of team performance : assuming design ated roles independently , completing goals ( tasks ) assigned to each role , and directed communication . Measures for improvement : Participants grade d their performance of specific organizational and treatment tasks within specified time intervals by consensus . Simulator “ survival ” depended on supporting oxygenation , ventilation , circulation within 60 seconds , and delivering the definitive treatment within 3 minutes . Effects of change : Simulated survival ( following predetermined criteria for death ) increased from 0 % to 89 % . The initial team task completion rate was 10–45 % and rose to 80–95 % during the third session . Lessons learnt : Training multidisciplinary teams to organize using simulation technology is feasible . This preliminary report warrants more detailed inquiry BACKGROUND Critical pediatric illness or injury occurs infrequently in out-of-hospital setting s , making it difficult for paramedics to maintain physical assessment , treatment , and procedure skills . OBJECTIVES To document the ability of paramedics to retain clinical knowledge over a one-year interval after completing a pediatric resuscitation course and to determine whether clinical experience or retesting improves retention . METHODS This was a r and omized controlled study assessing retention of knowledge in pediatric resuscitation soon after , six months after , and 12 months following completion of a pediatric advanced life support course . Forty-three paramedics participated in pre- and post-pediatric resuscitation course testing and were r and omly assigned to one of four groups . Group 1 received a knowledge examination ( KE ) and mock resuscitation scenarios ( MR ) at six months . Group 2 received only the KE at six months . Group 3 received the MR only at six months . Group 4 received no intermediate testing . All groups were reassessed at 12 months . RESULTS Pediatric clinical knowledge ( as measured by KE ) rose sharply immediately after the course but returned to baseline levels within six months . There was no difference between the groups in knowledge scores at 12 months , despite the interventions at six months . CONCLUSIONS Although intensive out-of-hospital pediatric education enhances knowledge , that knowledge rapidly decays . Emergency medical services programs need to find novel ways to increase retention and ensure paramedic readiness 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 
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Findings of the review were : SRTs result in an improvement in knowledge and skills in those who attend them , deterioration in skills and , to a lesser extent , knowledge is highly likely as early as three months following SRTs , booster or refresher sessions may improve an individual 's ability to retain resuscitation skills after initial training and the instigation of resuscitation training in a healthcare institution significantly improves clinical management of resuscitations and patient outcome ( including survival ) after resuscitation attempts