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SUMMARY STATEMENT: The optimal strategy for training cardiopulmonary resuscitation (CPR) for healthcare professionals remains to be determined. This scoping review aimed to describe the emerging evidence for CPR training for healthcare professionals.We screened 7605 abstracts and included 110 studies in this scoping review on CPR training for healthcare professionals. We assessed the included articles for evidence for the following topics: training duration, retraining intervals, e-learning, virtual reality/augmented reality/gamified learning, instructor-learner ratio, equipment and manikins, other aspects of contextual learning content, feedback devices, and feedback/debriefing. We found emerging evidence supporting the use of low-dose, high-frequency training with e-learning to achieve knowledge, feedback devices to perform high-quality chest compressions, and in situ team simulations with debriefings to improve the performance of provider teams.

ObjectivesVideo-assisted debriefing (VAD) of real-life obstetrical emergencies provides an opportunity to improve quality of care, but is rarely used in clinical practice. A barrier for implementation is the expected mental reservations among healthcare providers. The aim of this study was to explore healthcare providers’ perceptions and expectations of VAD of real-life events.SettingParticipants were recruited from two Labour and Delivery Units in Denmark. In both units, VAD of real-life obstetrical emergencies had never been conducted.Participants22 healthcare providers (10 physicians, 9 midwives and 3 nursing assistants). During the study period (August–October 2021), semi-structured, individual interviews were conducted. Interviews were analysed using thematic analysis.Primary and secondary outcome measuresA qualitative description of healthcare providers’ perceptions and expectations of VAD of real-life events.ResultsThree major themes were identified: (1)Video-assisted debriefing (VAD) as an opportunity for learning:All participants expected VAD to provide an opportunity for learning and improving patient care. All participants expected the video to provide a ‘bigger picture’, by showing ‘what was actually done’ instead of ‘what we believed was done’. (2)Video-assisted debriefing (VAD) as a cause for concern:The primary concern for all participants was the risk of being exposed as less competent. Participants were concerned that being confronted with every minor detail of their clinical practice would enhance their self-criticalness. (3)Preconditions for video-assisted debriefing (VAD):Participants emphasised the importance of organisational support from management. In addition, creating a safe environment for VAD, for example, by using only expert debriefers was considered an essential precondition for successful implementation.ConclusionsThe risk of being exposed as less competent was a barrier towards VAD of real-life events. However, the majority found the educational benefits to outweigh the risk of being exposed.

Introduction: Little is known about the optimal simulation-based team training in obstetric emergencies. We aimed to review how simulation-based team training affects patient outcomes in obstetric emergencies. Material and methods: Search Strategy: MEDLINE, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were searched up to and including May 15, 2021. Selection criteria: randomized controlled trials (RCTs) and cohort studies on obstetric teams in high-resource settings comparing the effect of simulation-based obstetric emergency team training with no training on the risk of Apgar scores less than 7 at 5 min, neonatal hypoxic ischemic encephalopathy, severe postpartum hemorrhage, blood transfusion of four or more units, and delay of emergency cesarean section by more than 30 min. Data collection and analysis: The included studies were assessed using PRISMA, EPCO, and GRADE. Results: We found 21 studies, four RCTs and 17 cohort studies, evaluating patient outcomes after obstetric team training compared with no training. Annual obstetric emergency team training may reduce brachial plexus injury (six cohort studies: odds ratio [OR] 0.47, 95% CI 0.33–0.68; one RCT: OR 1.30, 95 CI% 0.39–4.33, low certainty evidence) and suggest a positive effect; but it was not significant on Apgar score below 7 at 5 min (three cohort studies: OR 0.77, 95% CI 0.51–1.19; two RCT: OR 0.87, 95% CI 0.72–1.05, moderate certainty evidence). The effect was unclear for hypoxic ischemic encephalopathy, umbilical prolapse, decision to birth interval in emergency cesarean section, and for severe postpartum hemorrhage. Studies with in situ multi-professional simulation-based training demonstrated the best effect. Conclusions: Emerging evidence suggests an effect of obstetric team training on obstetric outcomes, but conflicting results call for controlled trials targeted to identify the optimal methodology for effective team training.

Pregnant women who are obese are at greater risk of pregnancy complications, including preeclampsia, gestational diabetes, and macrosomia, leading to an increased likelihood of induced labor. Little is known about pregnant women with obesity and the dose of Misoprostol needed for induction of labor (IOL). To investigate whether the cumulative dose of Misoprostol needed for induction of labor (IOL) is associated with women's body mass index (BMI), we conducted a retrospective study of the use of oral Misoprostol for IOL at the Department of Obstetrics and Gynecology, Aarhus University Hospital – a tertiary referral delivery unit with 4800 deliveries a year. Data on IOL among 1637 women with singleton pregnancies was collected in the period January 1st, 2014, to October 4th, 2017. Low-risk women were induced in an outpatient setting. Primary outcomes were Misoprostol dose, time between start of induction (first dose of Angusta®) and completed delivery, and mode of delivery. Secondary outcomes were neonatal data as Apgar score and pH of the umbilical artery. In this study, we found the total dose of Misoprostol needed for induction increased significantly with increasing BMI (p < 0.005). The time to delivery and the risk of Cesarean section increased with rising BMI class. However, 76% of inductions among the women with obesity ended in a vaginal delivery. For the neonatal outcomes, a total of 16 children had an Apgar score below 7 at five minutes and 14 had a pH less than 7.0; none of these results differed significantly between BMI classes. The perinatal and maternal mortality rate was 0%.

It is common practice after a pelvic exam to ask a woman to put her pants on, before she is given verbal information. We aimed to compare short-term memory in undressed versus dressed women.Thirty-six female Ob/Gyn doctors were randomised to receive verbal information while undressed and still in a lithotomy position, or once dressed again. The primary outcome was the proportion of items recalled from a 20-item list.We found no significant difference in recall; 58% in dressed women versus 62% in undressed women (p = 0.26).The memory of women is not affected by, whether or not they are dressed.none.none.

INTRODUCTION: It is common practice after a pelvic exam to ask a woman to put her pants on, before she is given verbal information. We aimed to compare short-term memory in undressed versus dressed women.METHODS: Thirty-six female Ob/Gyn doctors were randomised to receive verbal information while undressed and still in a lithotomy position, or once dressed again. The primary outcome was the proportion of items recalled from a 20-item list.RESULTS: We found no significant difference in recall; 58% in dressed women versus 62% in undressed women (p = 0.26).CONCLUSION: The memory of women is not affected by, whether or not they are dressed.FUNDING: none.TRIAL REGISTRATION: none.

Introduction and hypothesis: The objective was to investigate whether endoanal ultrasound (EAUS) performed 10 days after a primary repaired obstetric anal sphincter injury (OASIS) can predict the severity of anal incontinence (AI) in the long term. Methods: This prospective cohort study included women with a primary repaired 3b-degree tear, 3c-degree tear or fourth-degree tear at Aarhus University Hospital, Denmark, from 1 September 2010 to 31 May 2011. Clinical assessment and EAUS were performed on day 2, day 10, and day 20 after delivery. Functional outcomes were assessed using a questionnaire at the time of all clinical visits and at the long-term follow-up, 7 years after delivery. AI was graded according to the Wexner score and EAUS defects were graded according to the Starck score. Results: Ninety-six out of 99 women consented to participate. Five women had a secondary sphincter repair and were subsequently excluded from follow-up. Fifty-seven women underwent both EAUS 10 days after delivery and answered the long-term follow-up questionnaire. Median follow-up time was 7.7 years (IQR 7.4–7.8). Mean Wexner score was 4.4 ± 4.8 10 days after delivery and 2.5 ± 2.8 at follow-up; thus, the Wexner score improved over time (p = 0.01). Ultrasound sphincter defects were found in 82.6% of the women. Mean Starck score was 3.0 ± 1.8. The risk of AI was 0% (95% CI 0.0–30.8) if the Starck score was 0. No correlation was found between the Starck score and the Wexner score at follow-up. Conclusions: We found that performing EAUS in the puerperium following OASIS has limited value in predicting long-term AI.

Introduction: This study aimed to develop a valid and reliable TeamOBS-PPH tool for assessing clinical performance in the management of postpartum hemorrhage (PPH). The tool was evaluated using video-recordings of teams managing PPH in both real-life and simulated settings. Material and methods: A Delphi panel consisting of 12 obstetricians from the UK, Norway, Sweden, Iceland, and Denmark achieved consensus on (i) the elements to include in the assessment tool, (ii) the weighting of each element, and (iii) the final tool. The validity and reliability were evaluated according to Cook and Beckman. (Level 1) Four raters scored four video-recordings of in situ simulations of PPH. (Level 2) Two raters scored 85 video-recordings of real-life teams managing patients with PPH ≥1000 mL in two Danish hospitals. (Level 3) Two raters scored 15 video-recordings of in situ simulations of PPH from a US hospital. Results: The tool was designed with scores from 0 to 100. (Level 1) Teams of novices had a median score of 54 (95% CI 48–60), whereas experienced teams had a median score of 75 (95% CI 71–79; p < 0.001). (Level 2) The intra-rater [intra-class correlation (ICC) = 0.96] and inter-rater (ICC = 0.83) agreements for real-life PPH were strong. The tool was applicable in all cases: atony, retained placenta, and lacerations. (Level 3) The tool was easily adapted to in situ simulation settings in the USA (ICC = 0.86). Conclusion: The TeamOBS-PPH tool appears to be valid and reliable for assessing clinical performance in real-life and simulated settings. The tool will be shared as the free TeamOBS App.

IntroductionWe aimed to investigate whether noise in delivery rooms is associated with impaired performance of obstetric teams managing major (≥1000 mL) postpartum hemorrhage.Material and methodsWe included video recordings of 96 obstetric teams managing real-life major postpartum hemorrhage. Exposure was noise defined as the occurrence of sound level pressures (SPL) above 90 dB. The outcome was high clinical performance assessed through expert ratings using the TeamOBS-PPH tool.ResultsThe 23 teams unexposed to noise had a significantly higher chance of high clinical performance than the 73 teams exposed to noise: 91.3% (95% CI; 72.0-98.9) versus 58.9% (95% CI; 46.8-70.3) (p < 0.001). The results remained significant when adjusting for the following possible confounders: team size, non-technical performance, bleeding velocity, hospital type, etiology of bleeding, event duration and time of day. Typical sources of noise above 90 dB SPL were mother or baby crying, dropping of instruments, and slamming of cupboard doors.ConclusionNoise in delivery rooms may be an independent source of impaired clinical performance.

Delivering high-quality emergency care is the ambition for every emergency team. To succeed requires not only that the individual provider is well trained; it also commands a rapid and coordinated team effort.1 2 However, performance often falls short of expectations.3–5 Therefore, strategies like simulation training, audits, feedback and debriefings have been studied.6–10 Furthermore, filming of emergency teams was introduced back in 1969.11 Filming makes it possible to review and analyse the performance in detail.12–14 Despite the widespread availability and acceptability of video as a method for auditing and quality improvement in healthcare today,15 16 it is still not used by the majority of emergency teams.17 This review describes current evidence for video review to audit emergency teams ’ management of real-life patients . Video review is defined in this manuscript as any assessment, evaluation or audit where video is used The key questions in this systematic review are 1. Where has video review been used; populations and settings? 2. How has video review been used; technical solutions, legal and ethical issues? 3. What is the evidence that video review improves patient care? This systematic review used the protocol for systematic reviews (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols).18 The full study protocol in registered with PROSPERO. ### Eligibility criteria The eligibility criteria were based on the PICOS (Population, Intervention, Control, Outcome and Study design) guideline.19 Population was resuscitation teams, code teams, emergency teams, trauma teams, rapid response teams in hospitals. Intervention was video review. Control/comparison was non-exposed teams. Outcome was any assessment of the team’s performance and/or patient outcome. Study designs eligible for inclusion include randomised controlled trials (RCTs) and non-randomised studies (non-RCTs, interrupted time series, controlled before-and-after studies, cohort studies) and cross-sectional studies. Studies of single case reports and unpublished studies (eg, conference abstract …

Objective: Little is known about how teams’ non-technical performance influences clinical performance in obstetric emergencies such as postpartum haemorrhage. Design: Video review – observational study. Setting: A university hospital (5000 deliveries) and a regional hospital (2000 deliveries) in Denmark. Population: Obstetric teams managing real-life postpartum haemorrhage. Methods: We systematically assessed 99 video recordings of obstetric teams managing real-life major postpartum haemorrhage. Exposure was the non-technical score (AOTP); outcomes were the clinical performance score (TeamOBS) and the delayed transfer to the operating theatre (defined as blood loss >1500 ml in the delivery room). Results: Teams with an excellent non-technical score performed significantly better than teams with a poor non-technical score: 83.7 versus 0.3% chance of a high clinical performance score (P