Did we finally slay the evil dragon of cigarette smoking in the late 20th century?: unfortunately, the answer is no - the dragon is still alive and well in the 21st century and living in the third world. Shame on us!

If cigarettes were introduced as a new consumer product today, it is unlikely they would receive government regulatory approval. Cigarettes have proven biologic toxicities (carcinogenesis, atherogenesis, teratogenesis) and well-established causal links to human disease. Things were very different in 1913 when the R.

Short-term and long-term impact of the central line workshop on resident clinical performance during simulated central line placement.

Introduction: The Central Line Workshop (CLW) was introduced at our institution to better train residents in safe placement of the central venous catheter (CVC). This study sought to determine if immediate performance improvements from the CLW are sustained 3 months after the training for residents with various levels of experience.

Methods: Twenty-six emergency medicine residents completed the CLW, which includes online modules and experiential sessions in anatomy, ultrasound, sterile technique, and procedural task training.

Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial.

Objective: To evaluate a mastery learning, simulation-based curriculum for laparoscopic, totally extraperitoneal (TEP) inguinal hernia repair.

Background: Clinically relevant benefits from improvements in operative performance, time, and errors after simulation-based training are not clearly established.

Methods: After performing a baseline TEP in the OR, general surgery residents randomized to mastery learning (ML) or standard practice (SP) were reassessed during subsequent TEPs.

Evaluating the impact of simulation on translational patient outcomes.

Introduction: A long and rich research legacy shows that under the right conditions, simulation-based medical education (SBME) is a powerful intervention to increase medical learner competence. SBME translational science demonstrates that results achieved in the educational laboratory (T1) transfer to improved downstream patient care practices (T2) and improved patient and public health (T3).

Method: This is a qualitative synthesis of SBME translational science research (TSR) that employs a critical review approach to literature aggregation.

Simulation-based objective assessment discerns clinical proficiency in central line placement: a construct validation.

Background: Central venous catheterization (CVC) is associated with patient risks known to be inversely related to clinician experience. We developed and evaluated a performance assessment tool for use in a simulation-based central line workshop. We hypothesized that instrument scores would discriminate between less experienced and more experienced clinicians.

Simulation for clinical research trials: a theoretical outline.

Although medical simulation has not been shown to directly save lives, mounting evidence highlights its ability to decrease clinical protocol violations, increase adherence to guidelines, decrease time to competence, enhance team performance, and increase patient safety. These clinical insights suggest that simulation might offer similar improvements in the design, enrollment, and execution of complex phase 3 clinical research trials. This article provides a theoretical outline of why and how this could be done.

Iatrogenic delirium and coma: a "near miss".

A 66-year-old woman was cared for at two referral institutions following a witnessed cardiac arrest in a local emergency department. Despite aggressive initial care, she failed to regain consciousness during a 28-day course. Based on an erroneous neurologic diagnosis of anoxic encephalopathy, pessimism regarding likelihood of improvement existed, prompting clinical consideration of withdrawal of care.

The mayo high performance teamwork scale: reliability and validity for evaluating key crew resource management skills.

Purpose: To develop and evaluate a participant rating scale for assessing high performance teamwork skills in simulation medicine settings.

Methods: In all, 107 participants in crisis resource management (CRM) training in a multidisciplinary medical simulation center generated 273 ratings of key CRM skills after participating in two or three simulation exercises. These data were analyzed using Rasch and traditional psychometric approaches to develop the 16-item Mayo High Performance Teamwork Scale (MHPTS).

Simulation medicine in intensive care and coronary care education.

The training of physician learners in intensive care and coronary care medicine presents several unique challenges that are particularly suited to simulation-based medical education (SBME) solutions. Intensive care medical educators seek to provide evidence-based medical education and comprehensive clinical exposure for learners in the setting of maximal individual patient comfort and safety. This represents both a practical and ethical dilemma for educators - one that SBME can partially solve in a way that provides significant advantages over conventional "bedside" training, particularly in the intensive care setting among critically ill patients.

Internal medicine resident education in the medical intensive care unit: the impact on education and patient care of a scheduling change for didactic sessions.

Objective: Modifications in residency educational programs are needed to comply with the work-hour limitations introduced by the Accreditation Council for Graduate Medical Education. The objective of this study was to determine the impact of rescheduling critical care didactic sessions on medicine residents' education during their medical intensive care unit (MICU) rotation and on outcomes.

Design: A pilot program of nonrandomized design.

Intensive care unit support and Acute Physiology and Chronic Health Evaluation III performance in hematopoietic stem cell transplant recipients.

Objective: Hematopoietic stem cell transplant (HSCT) recipients admitted to the intensive care unit (ICU) have high mortality. The prognostic importance of peripheral blood stem cell source in critically ill HSCT recipients and the performance of Acute Physiology and Chronic Health Evaluation (APACHE) III have not been well studied. In a previous study, the hospital mortality rate of HSCT recipients admitted to our ICU was 77%.