***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: Accidents in developing countries are frequent and have high mortality and morbidity rates . In Brazil , in 1995 - 1996 , the year of this study , life supporting first aid ( LSFA ) , which includes cardiopulmonary resuscitation ( CPR ) basic life support ( BLS ) was not taught in schools . With the population of 165 million , the only way to teach the adult population on a large scale would be by television ( TV ) , that is widely viewed . This study compares two groups of factory employees - 86 controls without TV exposure to LSFA and 116 exposed to brief LSFA skill demonstrations on TV .  Their ability to acquire eight LSFA skills was evaluated : external hemorrhage control ; immobilization of a suspected forearm fracture ; treatment of a skin burn by cold flush ; body alignment after a fall ; positioning for shock and coma ; airway control by backward tilt of the head ; and CPR ( steps A-B-C ) . Simulated skill performance on the evaluating nurse or manikin was tested at 1 week , 1 month , and 13 months . In the control group , 1 - 31 % performed individual skills correctly ; as compared to 9 - 96 % of the television group ( P<0.001 ) . There was excellent retention over 13 months . Over 50 % of the television group performed correctly five of the eight skills , including positioning and hemorrhage control . Television viewing increased correct airway control performance from 5 to 25 % of trainees , while it remained at 3 % in the control group . CPR-ABC performance , however , was very poor in both groups . We conclude that a significant proportion of factory workers can acquire simple LSFA skills through television viewing alone , except for the skill acquisition of CPR steps B ( mouth-to-mouth ventilation ) and C ( external chest compressions ) which need coached manikin practice OBJECTIVES : To test the hypothesis that pediatric shock is a common cause of death and functional morbidity and that pediatric advanced life support (PALS)/advanced pediatric life support ( APLS ) resuscitation in the community hospital setting improves child health outcomes . METHODS : This study included all children consecutively transported to 5 regional , tertiary care children 's hospitals over 4 years , and is a prospect i ve cohort study comparing outcomes in children who did or did not receive PALS/APLS resuscitation in the community hospital . RESULTS : Shock occurred in 37 % of the patients transferred to the tertiary centers . Regardless of trauma status , children with shock had an increased mortality rate compared with those without shock ( all patients : 11.4 % vs 2.6 % ) , trauma patients ( 28.3 % vs 1.2 % ) , and nontrauma patients ( 10.5 % vs 2.8 % ) . Early shock reversal was associated with reduced mortality ( 5.06 % vs 16.37 % ) and functional morbidity ( 1.56 % vs 4.11 % ) rates . Early use of PALS/APLS-recommended interventions was associated with reduced mortality ( 8.69 % vs 15.01 % ) and functional morbidity ( 1.24 % vs 4.23 % ) rates . After controlling for center , severity of illness , and trauma status , early reversal of shock and use of PALS/APLS-recommended interventions remained associated with reduced morbidity and mortality rates . CONCLUSIONS : Shock is common in children who are transferred for tertiary care . Pediatric shock recognition and resuscitation in the community hospital improves survival and functional outcome regardless of diagnostic category . The development of shock/trauma systems for children with and without trauma seems prudent Current Advanced Cardiac Life Support ( ACLS ) course instruction involves a 2-day course with traditional lectures and limited team interaction . We wish to explore the advantages of a scenario-based performance-oriented team instruction ( SPOTI ) method to implement core ACLS skills for non-English-speaking international paramedic students . The objective of this study was to determine if scenario-based , performance-oriented team instruction ( SPOTI ) improves educational outcomes for the ACLS instruction of Korean paramedic students . Thirty Korean paramedic students were r and omly selected into two groups . One group of 15 students was taught the traditional ACLS course . The other 15 students were instructed using a SPOTI method . Each group was tested using  ACLS megacode examinations  endorsed by the American Heart Association . All 30 students passed the ACLS megacode examination . In the traditional ACLS study group an average of 85 % of the core skills were met . In the SPOTI study group an average of 93 % of the core skills were met . In particular , the SPOTI study group excelled at physical examination skills such as airway opening , assessment of breathing , signs of circulation , and compression rates . In addition , the SPOTI group performed with higher marks on rhythm recognition compared to the traditional group . The traditional group performed with higher marks at providing proper drug dosages compared to the SPOTI students . However , the students enrolled in the SPOTI method result ed in higher megacode core compliance scores compared to students trained in traditional ACLS course instruction . These differences did not achieve statistical significance due to the small sample size Background Birth asphyxia kills 0.7 to 1.6 million newborns a year globally with 99 % of deaths in developing countries . Effective newborn resuscitation could reduce this burden of disease but the training of health-care providers in low income setting s is often out date d. Our aim was to determine if a simple one day newborn resuscitation training ( NRT ) alters health worker resuscitation practice s in a public hospital setting in Kenya . Methods /Principal Findings We conducted a r and omised , controlled trial with health workers receiving early training with NRT ( n = 28 ) or late training ( the control group , n = 55 ) . The training was adapted locally from the approach of the UK Resuscitation Council . The primary outcome was the proportion of appropriate initial resuscitation steps with the frequency of inappropriate practice s as a secondary outcome . Data were collected on 97 and 115 resuscitation episodes over 7 weeks after early training in the intervention and control groups respectively . Trained providers demonstrated a higher proportion of adequate initial resuscitation steps compared to the control group ( trained 66 % vs control 27 % ; risk ratio 2.45 , [ 95 % CI 1.75–3.42 ] , p<0.001 , adjusted for clustering ) . In addition , there was a statistically significant reduction in the frequency of inappropriate and potentially harmful practice s per resuscitation in the trained group ( trained 0.53 vs control 0.92 ; mean difference 0.40 , [ 95 % CI 0.13–0.66 ] , p = 0.004 ) . Conclusions / Significance Implementation of a simple , one day newborn resuscitation training can be followed immediately by significant improvement in health workers ' practice s. However , evidence of the effects on long term performance or clinical outcomes can only be established by larger cluster r and omised trials . Trial Registration Controlled-Trials.com IS RCT CONTEXT Advanced cardiac life support ( ACLS ) training was introduced to bring order and a systematic approach to the treatment of cardiac arrest by professional responders . In spite of the wide dissemination of ACLS training , it has been difficult to demonstrate improved outcome following such training . OBJECTIVE To determine the value of formal ACLS training in improving survival from in-hospital cardiac arrest . DESIGN , SETTING , AND PARTICIPANTS A multi-center , prospect i ve cohort study examined patient outcomes after resuscitation efforts by in-hospital rescue teams with and without ACLS-trained personnel .  A total of 156 patients , experiencing 172 in-hospital cardiopulmonary arrest events over a 38-month period ( January 1998 to March 2001 ) were studied . MAIN OUTCOME MEASURES Primary endpoints included return of spontaneous circulation ( ROSC ) , survival to hospital discharge , 30-day survival , and 1-year survival . RESULTS The immediate success of resuscitation efforts for all patients was 39.7 % ( 62/156 ) . There was a significant increase in ROSC with ACLS-trained personnel ( 49/113 ; 43.4 % ) versus no ALCS-trained personnel ( 16/59 ; 27.1 % ; p=0.04 ) . Likewise , patients treated by ACLS-trained personnel had increased survival to hospital discharge ( 26/82 ; 31.7 % versus 7/34 ; 20.6 % ; p=0.23 ) , significantly better 30-day survival ( 22/82 ; 26.8 % versus 2/34 ; 5.9 % ; p<0.02 ) , and significantly improved 1-year survival ( 18/82 ; 21.9 % versus 0/34 ; 0 % ; p<0.002 ) . CONCLUSION The presence of at least one ACLS-trained team member at in-hospital resuscitation efforts increases both short and long-term survival following cardiac arrest OBJECTIVE To evaluate the effectiveness of the American Academy of Pediatrics Neonatal Resuscitation Program ( NRP ) in improving knowledge , skills , and self-efficacy of nurse midwives in low-risk delivery clinics in a developing country . STUDY DESIGN We used the content specifications of the NRP material applicable to college-educated nurse midwives working in low-risk clinics in Zambia to develop performance and self-efficacy evaluations focused on principles of resuscitation , initial steps , ventilation , and chest compressions . These evaluations were administered to 127 nurse midwives before and after NRP training and 6-months later . RESULTS After training , written scores ( knowledge evaluation ) improved from 57%+/-14 % to 80%+/-12 % ( mean+/-SD ; P < .0001 ) ; performance scores ( skills evaluation ) improved the most from 43%+/-21 % to 88%+/-9 % ( P < .0001 ) ; self-efficacy scores improved from 74%+/-14 % to 90%+/-10 % ( P < .0001 ) . Written and performance scores decreased significantly 6 months after training , but self-efficacy scores remained high . CONCLUSIONS As conducted , the NRP training improved educational outcomes in college-educated practicing nurse midwives . Pre-training knowledge and skills scores were relatively low despite the advanced formal education and experience of the participants , whereas the self-efficacy scores were high . NRP training has the potential to substantially improve knowledge and skills of neonatal resuscitation Dengue hemorrhagic fever is an important cause of morbidity among Asian children , and the more severe dengue shock syndrome ( DSS ) causes a significant number of childhood deaths . DSS is characterized by a massive increase in systemic capillary permeability with consequent hypovolemia . Fluid resuscitation is critical , but as yet there have been no large trials to determine the optimal fluid regimen . We undertook a r and omized blinded comparison of 4 fluids ( dextran , gelatin , lactated Ringer 's , and " normal " saline ) for initial resuscitation of 230 Vietnamese children with DSS . All the children survived , and there was no clear advantage to using any of the 4 fluids , but the longest recovery times occurred in the lactated Ringer 's group . The most significant factor determining clinical response was the pulse pressure at presentation . A comparison of the colloid and crystalloid groups suggested benefits in children presenting with lower pulse pressures who received one of the colloids . Further large-scale studies , stratified for admission pulse pressure , are indicated BACKGROUND Of the 3.7 million neonatal deaths and 3.3 million stillbirths each year , 98 % occur in developing countries . An evaluation of community-based interventions design ed to reduce the number of these deaths is needed . METHODS With the use of a train-the-trainer model , local instructors trained birth attendants from rural communities in six countries ( Argentina , Democratic Republic of Congo , Guatemala , India , Pakistan , and Zambia ) in the World Health Organization Essential Newborn Care course ( which focuses on routine neonatal care , resuscitation , thermoregulation , breast-feeding , " kangaroo " [ skin-to-skin ] care , care of the small baby , and common illnesses ) and ( except in Argentina ) in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program ( which teaches basic resuscitation in depth ) . The Essential Newborn Care intervention was assessed among 57,643 infants with the use of a before- and -after design . The Neonatal Resuscitation Program intervention was assessed as a cluster-r and omized , controlled trial involving 62,366 infants . The primary outcome was neonatal death in the first 7 days after birth . RESULTS The 7-day follow-up rate was 99.2 % . After birth attendants were trained in the Essential Newborn Care course , there was no significant reduction from baseline in the rate of neonatal death from all causes in the 7 days after birth ( relative risk with training , 0.99 ; 95 % confidence interval [ CI ] , 0.81 to 1.22 ) or in the rate of perinatal death ; there was a significant reduction in the rate of stillbirth ( relative risk with training , 0.69 ; 95 % CI , 0.54 to 0.88 ; P=0.003 ) . In clusters of births in which attendants had been r and omly assigned to receive training in the Neonatal Resuscitation Program , as compared with control clusters , there was no reduction in the rates of neonatal death in the 7 days after birth , stillbirth , or perinatal death . CONCLUSIONS The rate of neonatal death in the 7 days after birth did not decrease after the introduction of Essential Newborn Care training of community-based birth attendants , although the rate 
    Output:
    
Resuscitation training in developing countries was well received and viewed as valuable training by the students and local counterparts .
Institution of training in trauma and newborn resuscitation in developing countries has significantly reduced mortality , but this has not been demonstrated with other training programs