human
***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: BACKGROUND An important facet of laparoscopic surgery is its psychomotor component . As this aspect of surgery gains attention , lessons from other psychomotor-intense fields such as athletics have led to an investigation of the benefits of " warming up " prior to entering the operating room . Practical implementation of established methods of warm-up is hampered by a reliance on special equipment and instrumentations that are not readily available . In light of emerging evidence of translatability between video-game play and operative performance , we sought to find if laparoscopic task performance improved after warming up on a mobile device balance game . MATERIAL S AND METHODS Laparoscopic novices were r and omized into either the intervention group ( n = 20 ) or the control group ( n = 20 ) . The intervention group played a mobile device balance game for 10 min while the control group did no warm-up whatsoever . Assessment was performed using two tasks on the ProMIS laparoscopic simulation system : " object positioning " ( where small beads are transferred between four cups ) and " tissue manipulation " ( where pieces of plastic are stretched over pegs ) . Metrics measured were time to task completion , path length , smoothness , h and dominance , and errors . RESULTS The intervention group made fewer errors : object positioning task 0.20 versus 0.70 , P = 0.01 , tissue manipulation task 0.15 versus 0.55 , P = 0.05 , total errors 0.35 versus 1.25 , P = 0.002 . The two groups performed similarly on the other metrics . CONCLUSIONS Warm-up using a mobile device balance game decreases errors on basic tasks performed on a laparoscopic surgery simulator , suggesting a practical way to warm-up prior to cases in the operating room Introduction : Patient-specific simulated rehearsal ( PsR ) of a carotid artery stenting procedure ( CAS ) enables the interventionalist to rehearse the case before performing the procedure on the actual patient by incorporating patient-specific computed tomographic data into the simulation software . This study aim ed to evaluate whether PsR of a CAS procedure can enhance the operative performance versus a virtual reality ( VR ) generic CAS warm-up procedure or no preparation at all . Methods : During a 10-session cognitive/technical VR course , medical residents were trained in CAS . Thereafter , in a r and omized crossover study , each participant performed a patient-specific CAS case 3 times on the simulator , preceded by 3 different tasks : a PsR , a generic case , or no preparation .  Technical performances were assessed using simulator-based metrics and expert-based ratings . Results : Twenty medical residents ( surgery , cardiology , radiology ) were recruited . Training plateaus were observed after 10 sessions for all participants . Performances were significantly better after PsR than after a generic warm-up or no warm-up for total procedure time ( 16.3 ± 0.6 vs 19.7 ± 1.0 vs 20.9 ± 1.1 minutes , P = 0.001 ) and fluoroscopy time ( 9.3 ± 0.1 vs 11.2 ± 0.6 vs 11.2 ± 0.5 minutes , P = 0.022 ) but did not influence contrast volume or number of roadmaps used during the “ real ” case . PsR significantly improved the quality of performance as measured by the expert-based ratings ( scores 28 vs 25 vs 25 , P = 0.020 ) . Conclusions : Patient-specific simulated rehearsal of a CAS procedure significantly improves operative performance , compared to a generic VR warm-up or no warm-up . This technology requires further investigation with respect to improved outcomes on patients in the clinical setting Objective : To assess the impact of warm-up on laparoscopic performance in the operating room ( OR ) . Background : Implementation of simulation-based training into clinical practice remains limited despite evidence to show that the improvement in skills is transferred to the OR . The aim of this study was to evaluate the impact of a short virtual reality warm-up training program on laparoscopic performance in the OP . Methods : Sixteen Laparoscopic Cholecystectomies were performed by 8 surgeons in the OR . Participants were r and omized to a group which received a preprocedure warm-up using a virtual reality simulator and no warm-up group . After the initial laparoscopic cholecystectomy all surgeons served as their own controls by performing another procedure with or without preoperative warm-up . All OR procedures were videotaped and assessed by 2 independent observers using the generic OSATS global rating scale ( from 7 to 35 ) . Results : There was significantly better surgical performance on the laparoscopic Cholecystectomy following preoperative warm-up , median 28.5 ( range = 18.5–32.0 ) versus median 19.25 ( range = 15–31.5 ) , P = 0.042 . The results demonstrated excellent reliability of the assessment tool used ( Cronbach 's & agr ; = 0.92 ) . Conclusion : This study showed a significant beneficial impact of warm-up on laparoscopic performance in the OP . The suggested program is short , easy to perform , and therefore realistic to implement in the daily life in a busy surgical department . This will potentially improve the procedural outcome and contribute to improved patient safety and better utilization of OR re sources Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND AND PURPOSE Surgery is a high-stakes " performance . " Yet , unlike athletes or musicians , surgeons do not engage in routine " warm-up " exercises before " performing " in the operating room . We study the impact of a preoperative warm-up exercise routine ( POWER ) on surgeon performance during laparoscopic surgery .  MATERIAL S AND METHODS Serving as their own controls , each subject performed two pairs of laparoscopic cases  , each pair consisting of one case with POWER ( + POWER ) and one without ( -POWER ) . Subjects were r and omly assigned to + POWER or -POWER for the initial case of each pairing , and all cases were performed ≥ 1 week apart . POWER consisted of completing an electrocautery skill task on a virtual reality simulator and 15 minutes of laparoscopic suturing and knot tying in a pelvic box trainer . For each case , cognitive , psychomotor , and technical performance data were collected during two different tasks : mobilization of the colon ( MC ) and intracorporeal suturing and knot tying ( iSKT ) . Statistical analysis was performed using SYSTAT v11.0 . RESULTS A total of 28 study cases ( 14+POWER , 14-POWER ) were performed by seven different subjects . Cognitive and psychomotor performance ( attention , distraction , workload , spatial reasoning , movement smoothness , posture stability ) were found to be significantly better in the + POWER group ( P ≤ 0.05 ) and technical performance , as scored by two blinded laparoscopic experts , was found to be better in the + POWER group for MC ( P=0.04 ) but not iSKT ( P=0.92 ) . Technical scores demonstrated excellent reliability using our assessment tool ( Cronbach ∝=0.88 ) . Subject performance during POWER was also found to correlate with intraoperative performance scores . CONCLUSIONS Urologic trainees who perform a POWER  approximately 1 hour before laparoscopic renal surgery demonstrate improved cognitive , psychomotor , and technical performance This study suggests that those who “ warm-up ” with select video games may have improved laparoscopic clinical task performance compared to those not engaged in “ warm-up . BACKGROUND Surgery is a skill-driven discipline . While other high-stake professions with comparable cognitive and psychomotor skill requirements often use warm-up exercises for achieving better proficiency , the effects of such practice have not been investigated sufficiently in surgical tasks . DESIGN Subjects performed st and ardized exercises as a preoperative warm-up , after which the st and ardized exercises were repeated in a r and omized order . In a variation to investigate the generalizability of preoperative warm-up , the experimental group was allowed to warm-up with the st and ardized exercises , after which a different task ( electrocautery simulation ) was performed . To investigate the effect of warm-up on fatigue , participants were involved in eight sessions ( four before night call , four after night call ) , after which the tasks were repeated . Results were analyzed using ANOVA to plot differences between warm-up and followup condition . RESULTS All outcomes measures demonstrated statistically significant improvements after all of the post-warm-up exercises ( p < 0.01 ) , and were seen in all groups with differing experience levels . In addition , the simple warm-up exercises led to a significant increase in proficiency in followup electrocautery task for the experimental group when compared with the control group ( p < 0.0001 ) . There was also significant improvement in performance of the fatigued group to approximately baseline performance ( p < 0.05 ) , although they were not able to reach their optimal potential performance . CONCLUSION Preoperative warm-up for 15 to 20 minutes with simple surgical exercises leads to a substantial increase in surgical skills proficiency during followup tasks BACKGROUND Preoperative simulation warm-up has been shown to improve performance and reduce errors in novice and experienced surgeons , yet existing studies have only investigated conventional laparoscopy . We hypothesized that a brief virtual reality ( VR ) robotic warm-up would enhance robotic task performance and reduce errors . STUDY DESIGN In a 2-center r and omized trial , 51 residents and experienced minimally invasive surgery faculty in General Surgery , Urology , and Gynecology underwent a vali date d robotic surgery proficiency curriculum on a VR robotic simulator and on the da Vinci surgical robot ( Intuitive Surgical Inc ) .  Once they successfully achieved performance benchmarks , surgeons were r and omized to either receive a 3- to 5-minute VR simulator warm-up or read a leisure book for 10 minutes before performing similar and dissimilar ( intracorporeal suturing ) robotic surgery tasks . The primary outcomes compared were task time , tool path length , economy of motion , technical , and cognitive errors . RESULTS Task time ( -29.29 seconds , p = 0.001 ; 95 % CI , -47.03 to -11.56 ) , path length ( -79.87 mm ; p = 0.014 ; 95 % CI , -144.48 to -15.25 ) , and cognitive errors were reduced in the warm-up group compared with the control group for similar tasks . Global technical errors in intracorporeal suturing ( 0.32 ; p = 0.020 ; 95 % CI , 0.06 - 0.59 ) were reduced after the dissimilar VR task . When surgeons were stratified by earlier robotic and laparoscopic clinical experience , the more experienced surgeons ( n = 17 ) demonstrated significant improvements from warm-up in task time ( -53.5 seconds ; p = 0.001 ; 95 % CI , -83.9 to -23.0 ) and economy of motion ( 0.63 mm/s ; p = 0.007 ; 95 % CI , 0.18 - 1.09 ) , and improvement in these metrics was not statistically significantly appreciated in the less-experienced cohort ( n = 34 ) . CONCLUSIONS We observed significant performance improvement and error reduction rates among surgeons of varying experience after VR warm-up for basic robotic surgery tasks . In addition , the VR warm-up reduced errors on a more complex task ( robotic suturing ) , suggesting the generalizability of the warm-up It has previously been shown that the metabolic acidaemia induced by a continuous warm-up at the ' lactate threshold ' is associated with a reduced accumulated oxygen deficit and decreased supramaximal performance . The aim of this study was to determine if an intermittent , high-intensity warm-up could increase oxygen uptake ( V02 ) without reducing the accumulated oxygen deficit , and thus improve supramaximal performance . Seven male 500 m kayak paddlers , who had represented their state , volunteered for this study . Each performed a grade d exercise test to determine V02max and threshold parameters . On subsequent days and in a r and om , counterbalanced order , the participants then performed a continuous or intermittent , high-intensity warm-up followed by a 2 min , all-out kayak ergometer test . The continuous warm-up consisted of 15 min of exercise at approximately 65 % V02max . The intermittent , high-intensity warm-up was similar , except that the last 5 min was replaced with five 10 s sprints at 200 % V02max , separated by 50 s of recovery at ~55 % V02max . Significantly greater ( P<0.05 ) peak power ( intermittent vs continuous : 629 ± 199 vs 601 ± 204W ) and average power ( intermittent vs continuous : 328±39.0 vs 321 ±42.4 W ) were recorded after the intermittent warm-up . There was no significant difference between conditions for peak V02 , total V02 or the accumulated oxygen deficit . The results of this study indicate that 2 min all-out kayak ergometer performance is significantly better after an intermittent rather than a continuous warm-up Introduction and hypothesisOur aim was to assess the impact of immediate preoperative laparoscopic warm-up using a simulator on intraoperative laparoscopic performance by gynecologic residents . Methods El 
    Output:
    
agent
***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: BACKGROUND An important facet of laparoscopic surgery is its psychomotor component . As this aspect of surgery gains attention , lessons from other psychomotor-intense fields such as athletics have led to an investigation of the benefits of " warming up " prior to entering the operating room . Practical implementation of established methods of warm-up is hampered by a reliance on special equipment and instrumentations that are not readily available . In light of emerging evidence of translatability between video-game play and operative performance , we sought to find if laparoscopic task performance improved after warming up on a mobile device balance game . MATERIAL S AND METHODS Laparoscopic novices were r and omized into either the intervention group ( n = 20 ) or the control group ( n = 20 ) . The intervention group played a mobile device balance game for 10 min while the control group did no warm-up whatsoever . Assessment was performed using two tasks on the ProMIS laparoscopic simulation system : " object positioning " ( where small beads are transferred between four cups ) and " tissue manipulation " ( where pieces of plastic are stretched over pegs ) . Metrics measured were time to task completion , path length , smoothness , h and dominance , and errors . RESULTS The intervention group made fewer errors : object positioning task 0.20 versus 0.70 , P = 0.01 , tissue manipulation task 0.15 versus 0.55 , P = 0.05 , total errors 0.35 versus 1.25 , P = 0.002 . The two groups performed similarly on the other metrics . CONCLUSIONS Warm-up using a mobile device balance game decreases errors on basic tasks performed on a laparoscopic surgery simulator , suggesting a practical way to warm-up prior to cases in the operating room Introduction : Patient-specific simulated rehearsal ( PsR ) of a carotid artery stenting procedure ( CAS ) enables the interventionalist to rehearse the case before performing the procedure on the actual patient by incorporating patient-specific computed tomographic data into the simulation software . This study aim ed to evaluate whether PsR of a CAS procedure can enhance the operative performance versus a virtual reality ( VR ) generic CAS warm-up procedure or no preparation at all . Methods : During a 10-session cognitive/technical VR course , medical residents were trained in CAS . Thereafter , in a r and omized crossover study , each participant performed a patient-specific CAS case 3 times on the simulator , preceded by 3 different tasks : a PsR , a generic case , or no preparation .  Technical performances were assessed using simulator-based metrics and expert-based ratings . Results : Twenty medical residents ( surgery , cardiology , radiology ) were recruited . Training plateaus were observed after 10 sessions for all participants . Performances were significantly better after PsR than after a generic warm-up or no warm-up for total procedure time ( 16.3 ± 0.6 vs 19.7 ± 1.0 vs 20.9 ± 1.1 minutes , P = 0.001 ) and fluoroscopy time ( 9.3 ± 0.1 vs 11.2 ± 0.6 vs 11.2 ± 0.5 minutes , P = 0.022 ) but did not influence contrast volume or number of roadmaps used during the “ real ” case . PsR significantly improved the quality of performance as measured by the expert-based ratings ( scores 28 vs 25 vs 25 , P = 0.020 ) . Conclusions : Patient-specific simulated rehearsal of a CAS procedure significantly improves operative performance , compared to a generic VR warm-up or no warm-up . This technology requires further investigation with respect to improved outcomes on patients in the clinical setting Objective : To assess the impact of warm-up on laparoscopic performance in the operating room ( OR ) . Background : Implementation of simulation-based training into clinical practice remains limited despite evidence to show that the improvement in skills is transferred to the OR . The aim of this study was to evaluate the impact of a short virtual reality warm-up training program on laparoscopic performance in the OP . Methods : Sixteen Laparoscopic Cholecystectomies were performed by 8 surgeons in the OR . Participants were r and omized to a group which received a preprocedure warm-up using a virtual reality simulator and no warm-up group . After the initial laparoscopic cholecystectomy all surgeons served as their own controls by performing another procedure with or without preoperative warm-up . All OR procedures were videotaped and assessed by 2 independent observers using the generic OSATS global rating scale ( from 7 to 35 ) . Results : There was significantly better surgical performance on the laparoscopic Cholecystectomy following preoperative warm-up , median 28.5 ( range = 18.5–32.0 ) versus median 19.25 ( range = 15–31.5 ) , P = 0.042 . The results demonstrated excellent reliability of the assessment tool used ( Cronbach 's & agr ; = 0.92 ) . Conclusion : This study showed a significant beneficial impact of warm-up on laparoscopic performance in the OP . The suggested program is short , easy to perform , and therefore realistic to implement in the daily life in a busy surgical department . This will potentially improve the procedural outcome and contribute to improved patient safety and better utilization of OR re sources Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND AND PURPOSE Surgery is a high-stakes " performance . " Yet , unlike athletes or musicians , surgeons do not engage in routine " warm-up " exercises before " performing " in the operating room . We study the impact of a preoperative warm-up exercise routine ( POWER ) on surgeon performance during laparoscopic surgery .  MATERIAL S AND METHODS Serving as their own controls , each subject performed two pairs of laparoscopic cases  , each pair consisting of one case with POWER ( + POWER ) and one without ( -POWER ) . Subjects were r and omly assigned to + POWER or -POWER for the initial case of each pairing , and all cases were performed ≥ 1 week apart . POWER consisted of completing an electrocautery skill task on a virtual reality simulator and 15 minutes of laparoscopic suturing and knot tying in a pelvic box trainer . For each case , cognitive , psychomotor , and technical performance data were collected during two different tasks : mobilization of the colon ( MC ) and intracorporeal suturing and knot tying ( iSKT ) . Statistical analysis was performed using SYSTAT v11.0 . RESULTS A total of 28 study cases ( 14+POWER , 14-POWER ) were performed by seven different subjects . Cognitive and psychomotor performance ( attention , distraction , workload , spatial reasoning , movement smoothness , posture stability ) were found to be significantly better in the + POWER group ( P ≤ 0.05 ) and technical performance , as scored by two blinded laparoscopic experts , was found to be better in the + POWER group for MC ( P=0.04 ) but not iSKT ( P=0.92 ) . Technical scores demonstrated excellent reliability using our assessment tool ( Cronbach ∝=0.88 ) . Subject performance during POWER was also found to correlate with intraoperative performance scores . CONCLUSIONS Urologic trainees who perform a POWER  approximately 1 hour before laparoscopic renal surgery demonstrate improved cognitive , psychomotor , and technical performance This study suggests that those who “ warm-up ” with select video games may have improved laparoscopic clinical task performance compared to those not engaged in “ warm-up . BACKGROUND Surgery is a skill-driven discipline . While other high-stake professions with comparable cognitive and psychomotor skill requirements often use warm-up exercises for achieving better proficiency , the effects of such practice have not been investigated sufficiently in surgical tasks . DESIGN Subjects performed st and ardized exercises as a preoperative warm-up , after which the st and ardized exercises were repeated in a r and omized order . In a variation to investigate the generalizability of preoperative warm-up , the experimental group was allowed to warm-up with the st and ardized exercises , after which a different task ( electrocautery simulation ) was performed . To investigate the effect of warm-up on fatigue , participants were involved in eight sessions ( four before night call , four after night call ) , after which the tasks were repeated . Results were analyzed using ANOVA to plot differences between warm-up and followup condition . RESULTS All outcomes measures demonstrated statistically significant improvements after all of the post-warm-up exercises ( p < 0.01 ) , and were seen in all groups with differing experience levels . In addition , the simple warm-up exercises led to a significant increase in proficiency in followup electrocautery task for the experimental group when compared with the control group ( p < 0.0001 ) . There was also significant improvement in performance of the fatigued group to approximately baseline performance ( p < 0.05 ) , although they were not able to reach their optimal potential performance . CONCLUSION Preoperative warm-up for 15 to 20 minutes with simple surgical exercises leads to a substantial increase in surgical skills proficiency during followup tasks BACKGROUND Preoperative simulation warm-up has been shown to improve performance and reduce errors in novice and experienced surgeons , yet existing studies have only investigated conventional laparoscopy . We hypothesized that a brief virtual reality ( VR ) robotic warm-up would enhance robotic task performance and reduce errors . STUDY DESIGN In a 2-center r and omized trial , 51 residents and experienced minimally invasive surgery faculty in General Surgery , Urology , and Gynecology underwent a vali date d robotic surgery proficiency curriculum on a VR robotic simulator and on the da Vinci surgical robot ( Intuitive Surgical Inc ) .  Once they successfully achieved performance benchmarks , surgeons were r and omized to either receive a 3- to 5-minute VR simulator warm-up or read a leisure book for 10 minutes before performing similar and dissimilar ( intracorporeal suturing ) robotic surgery tasks . The primary outcomes compared were task time , tool path length , economy of motion , technical , and cognitive errors . RESULTS Task time ( -29.29 seconds , p = 0.001 ; 95 % CI , -47.03 to -11.56 ) , path length ( -79.87 mm ; p = 0.014 ; 95 % CI , -144.48 to -15.25 ) , and cognitive errors were reduced in the warm-up group compared with the control group for similar tasks . Global technical errors in intracorporeal suturing ( 0.32 ; p = 0.020 ; 95 % CI , 0.06 - 0.59 ) were reduced after the dissimilar VR task . When surgeons were stratified by earlier robotic and laparoscopic clinical experience , the more experienced surgeons ( n = 17 ) demonstrated significant improvements from warm-up in task time ( -53.5 seconds ; p = 0.001 ; 95 % CI , -83.9 to -23.0 ) and economy of motion ( 0.63 mm/s ; p = 0.007 ; 95 % CI , 0.18 - 1.09 ) , and improvement in these metrics was not statistically significantly appreciated in the less-experienced cohort ( n = 34 ) . CONCLUSIONS We observed significant performance improvement and error reduction rates among surgeons of varying experience after VR warm-up for basic robotic surgery tasks . In addition , the VR warm-up reduced errors on a more complex task ( robotic suturing ) , suggesting the generalizability of the warm-up It has previously been shown that the metabolic acidaemia induced by a continuous warm-up at the ' lactate threshold ' is associated with a reduced accumulated oxygen deficit and decreased supramaximal performance . The aim of this study was to determine if an intermittent , high-intensity warm-up could increase oxygen uptake ( V02 ) without reducing the accumulated oxygen deficit , and thus improve supramaximal performance . Seven male 500 m kayak paddlers , who had represented their state , volunteered for this study . Each performed a grade d exercise test to determine V02max and threshold parameters . On subsequent days and in a r and om , counterbalanced order , the participants then performed a continuous or intermittent , high-intensity warm-up followed by a 2 min , all-out kayak ergometer test . The continuous warm-up consisted of 15 min of exercise at approximately 65 % V02max . The intermittent , high-intensity warm-up was similar , except that the last 5 min was replaced with five 10 s sprints at 200 % V02max , separated by 50 s of recovery at ~55 % V02max . Significantly greater ( P<0.05 ) peak power ( intermittent vs continuous : 629 ± 199 vs 601 ± 204W ) and average power ( intermittent vs continuous : 328±39.0 vs 321 ±42.4 W ) were recorded after the intermittent warm-up . There was no significant difference between conditions for peak V02 , total V02 or the accumulated oxygen deficit . The results of this study indicate that 2 min all-out kayak ergometer performance is significantly better after an intermittent rather than a continuous warm-up Introduction and hypothesisOur aim was to assess the impact of immediate preoperative laparoscopic warm-up using a simulator on intraoperative laparoscopic performance by gynecologic residents . Methods El 
    Output:
    