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 Background Multimodal strategies before surgery are often used to improve outcomes , but disease progression ( precluding surgical resection ) and inoperability at planned surgery still occur following neoadjuvant treatment . The st and ards of reporting of these outcomes have not previously been considered . This study examined reporting of rates of progression to surgical resection and inoperability at planned surgery following neoadjuvant treatment in surgical oncology , using esophageal cancer as a case study . Methods A systematic review identified r and omized trials and prospect i ve nonr and omized studies reporting short-term outcomes of neoadjuvant treatment and surgery for esophageal cancer . Results Of 4,763 abstract s , 224 papers were retrieved and 76 studies included ( 8 r and omized trials and 68 cohort studies of 19,441 esophagectomies ) . Articles reported outcomes of  preoperative chemotherapy  ( n = 33 , 43.4 % ) , chemoradiotherapy ( n = 13 , 17.1 % ) , or both within one paper ( n = 18 , 23.7 % ) and 12 ( 15.8 % ) did not specify the type of neoadjuvant treatment . Also , 20 papers ( 26.3 % ) reported numbers of patients not progressing to surgery after  neoadjuvant treatment  ( with rates of nonprogression ranging between 2.0 and 35.3 % ) . In addition , 24 papers ( 31.6 % ) reported rates of inoperability at planned surgery ( with inoperability rates ranging between 0 and 26.2 % ) . More r and omized controlled trials ( RCTs ) than observational studies reported nonprogression ( 4 r and omized and 16 nonr and omized studies , 95 % CI −9.6 to 62.6 % , p = 0.108 ) and inoperability ( 6 r and omized trials and 18 observational studies , 95 % CI 16.8–80.3 % , p = 0.005 ) . Some 17 and 10 articles provided reasons for the observed rates of nonprogression and inoperability , respectively . Conclusions Reporting rates of progression to surgery after neoadjuvant treatment and inoperability at planned surgery for esophageal cancer were poor , limiting data synthesis and comparisons . It is suggested that core outcome sets for trials in surgical oncology are developed with inclusion of these important endpoints . Collaboration between medical and surgical oncologists is necessary to achieve this AIM To investigate the effect of qualitatively different types of pedagogical feedback ( FB ) on the training , transfer and retention of basic manual dexterity dental skills using a virtual reality ( VR ) haptic dental simulator . METHODS Sixty-three participants ( M = 22.7 years ; SD = 3.4 years ) , with no previous dental training , were r and omly allocated to one of three groups ( n = 21 each ) . Group 1 received device-only feedback during the training phase , that is the visual display of the simulator ( DFB ) ; Group 2 received verbal feedback from a qualified dental instructor ( IFB ) ; and Group 3 received a combination of instructor and device feedback ( IDFB ) . Participants completed four tasks during which feedback was given according to group allocation as well as two skills transfer tests . Skill retention was examined immediately after training , at 1 week and at 1 month post-test . RESULTS Statistically significant differences were found between the groups in overall performance ( P < 0.001 ) and error ( P = 0.006 ) . Post hoc comparisons revealed the IDFB group produced substantially better performance and fewer errors in comparison with DFB and IFB training . This difference translated to improved performance in skill retention and generalisation of knowledge to novel tasks . CONCLUSION These data indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visual display (VR)-driven feedback . The results have implication s for the utility and implementation of VR haptic technology in dental education 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 Gynecol 
    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 Background Multimodal strategies before surgery are often used to improve outcomes , but disease progression ( precluding surgical resection ) and inoperability at planned surgery still occur following neoadjuvant treatment . The st and ards of reporting of these outcomes have not previously been considered . This study examined reporting of rates of progression to surgical resection and inoperability at planned surgery following neoadjuvant treatment in surgical oncology , using esophageal cancer as a case study . Methods A systematic review identified r and omized trials and prospect i ve nonr and omized studies reporting short-term outcomes of neoadjuvant treatment and surgery for esophageal cancer . Results Of 4,763 abstract s , 224 papers were retrieved and 76 studies included ( 8 r and omized trials and 68 cohort studies of 19,441 esophagectomies ) . Articles reported outcomes of  preoperative chemotherapy  ( n = 33 , 43.4 % ) , chemoradiotherapy ( n = 13 , 17.1 % ) , or both within one paper ( n = 18 , 23.7 % ) and 12 ( 15.8 % ) did not specify the type of neoadjuvant treatment . Also , 20 papers ( 26.3 % ) reported numbers of patients not progressing to surgery after  neoadjuvant treatment  ( with rates of nonprogression ranging between 2.0 and 35.3 % ) . In addition , 24 papers ( 31.6 % ) reported rates of inoperability at planned surgery ( with inoperability rates ranging between 0 and 26.2 % ) . More r and omized controlled trials ( RCTs ) than observational studies reported nonprogression ( 4 r and omized and 16 nonr and omized studies , 95 % CI −9.6 to 62.6 % , p = 0.108 ) and inoperability ( 6 r and omized trials and 18 observational studies , 95 % CI 16.8–80.3 % , p = 0.005 ) . Some 17 and 10 articles provided reasons for the observed rates of nonprogression and inoperability , respectively . Conclusions Reporting rates of progression to surgery after neoadjuvant treatment and inoperability at planned surgery for esophageal cancer were poor , limiting data synthesis and comparisons . It is suggested that core outcome sets for trials in surgical oncology are developed with inclusion of these important endpoints . Collaboration between medical and surgical oncologists is necessary to achieve this AIM To investigate the effect of qualitatively different types of pedagogical feedback ( FB ) on the training , transfer and retention of basic manual dexterity dental skills using a virtual reality ( VR ) haptic dental simulator . METHODS Sixty-three participants ( M = 22.7 years ; SD = 3.4 years ) , with no previous dental training , were r and omly allocated to one of three groups ( n = 21 each ) . Group 1 received device-only feedback during the training phase , that is the visual display of the simulator ( DFB ) ; Group 2 received verbal feedback from a qualified dental instructor ( IFB ) ; and Group 3 received a combination of instructor and device feedback ( IDFB ) . Participants completed four tasks during which feedback was given according to group allocation as well as two skills transfer tests . Skill retention was examined immediately after training , at 1 week and at 1 month post-test . RESULTS Statistically significant differences were found between the groups in overall performance ( P < 0.001 ) and error ( P = 0.006 ) . Post hoc comparisons revealed the IDFB group produced substantially better performance and fewer errors in comparison with DFB and IFB training . This difference translated to improved performance in skill retention and generalisation of knowledge to novel tasks . CONCLUSION These data indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visual display (VR)-driven feedback . The results have implication s for the utility and implementation of VR haptic technology in dental education 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 Gynecol 
    Output:
    