Prevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review

ABSTRACT Objective: to identify and synthesize the scientific evidence on cancer patient safety in the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Method: a scoping review, according to the Joanna Briggs Institute and to the recommendations of the PRISMA-ScR international guide. The research was conducted in five electronic databases, the Cochrane Library and eight catalogs of theses and dissertations. The inclusion criteria were the following: studies related to patient safety in the administration of antineoplastic and immunotherapeutic chemotherapy by nurses in places where cancer care occurs, published entirely in Portuguese, Spanish and/or English, with no time limit. The extracted data were analyzed and synthesized in narrative form. Results: a total of 14,444 records were retrieved and 47 studies were kept for review. Most publications (44.7%) had a qualitative approach, while 40.4% were quantitative and 14.9%, mixed. When summarizing the findings, the following themes emerged: Safety standards in parenteral administration of antineoplastic chemotherapy; Good practices for patient safety using oral antineoplastic therapy; Administration and safe handling of immunotherapies; Prevention and management of errors related to the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Conclusion: patients safety with cancer in the administration of antineoplastic therapy occurs when there is implementation of evidence-based protocols, continuing education of nurses and implementation of safety standards and processes, as a strategy to prevent errors in drug administration.

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Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy

10.26686/wgtn.12375746 ◽

2020 ◽

Author(s):

E Blix ◽

Robyn Maude ◽

E Hals ◽

S Kisa ◽

E Karlsen ◽

...

Keyword(s):

Scoping Review ◽

Meta Analysis ◽

Scientific Evidence ◽

Fetal Monitoring ◽

Low Risk ◽

Cochrane Library ◽

National Guidelines ◽

Creative Commons ◽

Active Labour ◽

Randomised Controlled

© 2019 Blix et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Intermittent auscultation (IA) is the technique of listening to and counting the fetal heart rate (FHR) for short periods during active labour and continuous cardiotocography (CTC) implies FHR monitoring for longer periods. Although the evidence suggests that IA is the best way to monitor healthy women at low risk of complications, there is no scientific evidence for the ideal device, timing, frequency and duration for IA. We aimed to give an overview of the field, identify and describe methods and practices for performing IA, map the evidence and accuracy for different methods of IA, and identify research gaps. Methods We conducted a systematic scoping review following the Joanna Briggs methodology. Med-line, EMBASE, Cinahl, Maternity & Infant Care, Cochrane Library, SveMed+, Web of Science, Scopus, Lilacs and African Journals Online were searched for publications up to January 2019. We did hand searches in relevant articles and databases. Studies from all countries, international guidelines and national guidelines from Denmark, United Kingdom, United States, New Zealand, Australia, The Netherlands, Sweden, Denmark, and Norway were included. We did quality assessment of the guidelines according to the AGREEMENT tool. We performed a meta-analysis assessing the effects of IA with a Doppler device vs. Pinard device using methods described in The Cochrane Handbook, and we performed an overall assessment of the summary of evidence using the GRADE approach. Results The searches generated 6408 hits of which 26 studies and 11 guidelines were included in the review. The studies described slightly different techniques for performing IA, and some did not provide detailed descriptions. Few of the studies provided details of normal and abnormal IA findings. All 11 guidelines recommended IA for low risk women, although they had slightly different recommendations on the frequency, timing, and duration for IA, and the FHR characteristics that should be observed. Four of the included studies, comprising 8436 women and their babies, were randomised controlled trials that evaluated the effect of IA with a Doppler device vs. a Pinard device. Abnormal FHRs were detected more often using the Doppler device than in those using the Pinard device (risk ratio 1.77; 95% confidence interval 1.29–2.43). There were no significant differences in any of the other maternal or neonatal outcomes. Four studies assessed the accuracy of IA findings. Normal FHR was easiest to identify correctly, whereas identifying periodic FHR patterns such as decelerations and saltatory patterns were more difficult. Conclusion Although IA is the recommended method, no trials have been published that evaluate protocols on how to perform it. Nor has any study assessed interrater agreements regarding interpretations of IA findings, and few have assessed to what degree clinicians can describe FHR patterns detected by IA. We found no evidence to recommend Doppler device instead of the Pinard for IA, or vice versa.

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How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations: A Systematic Scoping Review

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_075 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1358-1358

Author(s):

Susan Veldheer ◽

Christina Scartozzi ◽

Amy Knehans ◽

Tamara Oser ◽

Natasha Sood ◽

...

Keyword(s):

Data Collection ◽

Health Outcomes ◽

Selection Bias ◽

Scoping Review ◽

Fruits And Vegetables ◽

Cochrane Library ◽

Study Quality ◽

Healthcare Organizations ◽

Objective Health ◽

The Impact

Abstract Objectives There is compelling evidence that diet can prevent chronic disease, and with rising health care costs, healthcare organizations are attempting to identify new clinical interventions that can improve the diets of their patients. The purpose of this systematic scoping review was to understand what clinical strategies healthcare organizations are using to increase access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact on health outcomes. Methods Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from January 1, 1990 to December 31, 2019. Original studies must have included a healthcare organization and had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Project tool was used to assess study quality in 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts). Two reviewers independently verified included studies, study quality, and data extraction. Results A total of 8877 abstracts were screened which yielded 46 manuscripts from 30 studies. There were 6 program models identified including: 1) cash-back rebate programs, 2) prescription voucher programs, 3) garden-based programs, 4) subsidized food boxes/community supported agriculture (CSA) programs, 5) home-delivery meal programs, and 6) collaborative food pantry-clinical programs. Only 6/30 studies included a control group. The overall quality of the studies was weak due to study participant selection bias, and incomplete reporting on tools used for data collection, confounders, and dropouts. Generally, studies that measured dietary intake found some improvements after these interventions. Other objective health markers such as blood pressure and body mass index had mixed results. Conclusions Healthcare-based models currently being tested that provide patients with access to F&V are novel and appear to have promise. However, future studies will need to use rigorous study designs, validated data collection tools and more sophisticated data analysis methodologies to better determine the effect of these interventions on health outcomes. Funding Sources This study was funded with internal fund to RW and SV.

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“I’m Trying to Stop Things Before They Happen”: Carers’ Contributions to Patient Safety in Hospitals

Qualitative Health Research ◽

10.1177/1049732319841021 ◽

2019 ◽

Vol 29 (10) ◽

pp. 1508-1518 ◽

Cited By ~ 2

Author(s):

Bronwen Merner ◽

Sophie Hill ◽

Michael Taylor

Keyword(s):

Health Care ◽

Patient Safety ◽

Grounded Theory ◽

Data Collection ◽

High Intensity ◽

Adult Patients ◽

Constructivist Grounded Theory ◽

Negative Consequences ◽

Data Collection And Analysis ◽

Depth Interviews

Patient safety policies increasingly encourage carer (i.e., family or friends) involvement in reducing health care–associated harm in hospital. Despite this, carer involvement in patient safety in practice is not well understood—especially from the carers’ perspective. The purpose of this article is to understand how carers of adult patients perceived and experienced their patient safety contributions in hospital. Constructivist grounded theory informed the data collection and analysis of in-depth interviews with 32 carers who had patient safety concerns in Australian hospitals. Results demonstrated carers engaged in the process of “patient-safety caring.” Patient-safety caring included three levels of intensity: low (“contributing without concern”), moderate (“being proactive about safety”), and high (“wrestling for control”). Carers who engaged at high intensity provided the patient with greater protection, but typically experienced negative consequences for themselves. Carers’ experiences of negative consequences from safety involvement need to be mitigated by practice approaches that value their contributions.

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The Impact of Corticosteroids on Mortality in Adult Patients with Septic Shock

10.28971/532019ha94 ◽

2019 ◽

Author(s):

Anthony Henriques

Keyword(s):

Systematic Review ◽

Septic Shock ◽

Data Collection ◽

Patient Care ◽

Adult Patients ◽

Flow Diagram ◽

Cochrane Library ◽

Advanced Practice ◽

Pertinent Data ◽

The Impact

Septic shock is a complication that affects thousands of patients leading to high mortality rates and increased healthcare costs. One treatment in the attempt to decrease poor outcomes is corticosteroids. A systematic review was conducted to evaluate the impact of corticosteroids on mortality in adult patients with septic shock. Databases searched were CINAHL, PubMed, OVID, and Cochrane Library. A literature review was performed and pertinent data from each article was recorded in data collection tables. A total of six articles were critically analyzed. The Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and flow diagram were used to guide this systematic review. The Critical Appraisal Skills Programme (CASP) checklist assisted in assessing the quality of the articles selected. Cross study analysis was performed via the data collection tables developed by this author. This analysis revealed five of the six trials did not detect a decrease in mortality using corticosteroids in adult patients with septic shock; the sixth study did document a reduction in mortality rate. Four studies were underpowered which may affect the generalizability of their outcomes. Two studies were adequately powered with one demonstrating positive outcomes. Possible benefits were seen in the secondary outcomes such as faster resolution of shock and decreased vasopressor use. Advanced practice nurses are having an increased prominent role in patient care within healthcare. This role provides an opportunity for high quality evidence-based results to be applied to improve patient care. Results of this systematic review provide information to guide decision making by the advanced practice nurse as well as suggestions for further study.

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Smoking cessation interventions in South Asian countries: protocol for scoping review

BMJ Open ◽

10.1136/bmjopen-2020-038818 ◽

2021 ◽

Vol 11 (2) ◽

pp. e038818

Author(s):

Sajid Iqbal ◽

Rubina Barolia ◽

Laila Ladak ◽

Pammla Petrucka

Keyword(s):

Smoking Cessation ◽

South Asian ◽

Scoping Review ◽

Reference Lists ◽

Qualitative Content Analysis ◽

Grey Literature ◽

Developed Countries ◽

Cochrane Library ◽

Asian Countries ◽

Theses And Dissertations

IntroductionUnfortunately, like many other health risks, smoking rate has been on the rise in developing countries. Half of current smokers in the world reside in only three countries of Asia that include India. Many smoking cessation interventions that were developed and successfully implemented in the context of developed countries have not been equally successful in South Asia. Hence, there is a dire need of culturally relevant smoking cessation interventions. We propose a scoping review with objectives to explore the extent and nature of interventions for smoking cessation and its associated factors in South Asian Region by systematically reviewing the available published and unpublished literature.Methods and analysisThe review has been registered in Joanna Briggs Institute (JBI) systematic reviews register and details are given in the Methodology section. The updated framework of JBI for scoping review methodology will be used as guide for conduct of this scoping review. Electronic databases (PubMed, CINAHL plus, Proquest Theses and Dissertations, EBSCO Dentistry and Oral Sciences, and Wiley Cochrane Library), reference lists of selected studies and grey literature will be considered for inclusion in this review. The literature search is anticipated to be carried out in December–January 2020. Initially, two reviewers in consultation with a librarian will develop search syntax followed by search from the selected sources. Consequently, the reviewers will screen all the titles, abstracts and full articles to establish relevance of each study for inclusion. Factors associated with smoking cessation will be coded and categorised applying qualitative content analysis, while interventions extracted from the literature will be described with the stated level of effectiveness.

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Obstetrical safety indicators for preventing hospital harms: a scoping review protocol

10.1101/19012153 ◽

2019 ◽

Author(s):

Aislinn Conway ◽

Jessica Reszel ◽

Mark C Walker ◽

Jeremy M Grimshaw ◽

Sandra I Dunn

Keyword(s):

Patient Safety ◽

Patient Care ◽

Scoping Review ◽

Performance Indicators ◽

Full Text ◽

Cochrane Library ◽

Primary Concern ◽

Comprehensive List ◽

Scoping Reviews ◽

Review Protocol

Introduction: Optimizing the safety of obstetric patient care is a primary concern for many hospitals. Identifying performance indicators that measure aspects of patient care processes related to preventable harms can present opportunities to improve health systems. In this paper, we present our protocol for a scoping review to identify performance indicators for obstetric safety. We aim to identify a comprehensive list of obstetric safety indicators which may help reduce the number of preventable patient harms, to summarize the data and to synthesize the results. Methods and analysis: We will use the methodological framework described by Arksey and O Malley and further expanded by Levac. We will search multiple electronic databases such as Medline, Embase, CINAHL and the Cochrane Library as well as websites from professional bodies and other organisations, using an iterative search strategy. We will include indicators that relate to preventable harms in the process of obstetric care. Two reviewers will independently screen titles and abstracts of search results to determine eligibility for inclusion. For records where eligibility is not clear, the reviewers will screen the full text version. If reviewers decisions regarding eligibility differ, a third reviewer will review the full text record. Two reviewers will independently extract data from records that meet our inclusion criteria using a standardized data collection form. We will narratively describe quantitative data, such as the frequency with which indicators are identified, and conduct a thematic analysis of the qualitative data. We will compile a comprehensive list of patient safety indicators identified during our scoping review and organise them according to concepts that best suit the data such as the Donabedian model or the Hospital Harm Framework. We will discuss the implications of the indicators for future research, clinical practice and policy making. We will report the conduct of the review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA ScR) Checklist. Ethics and Dissemination: The sources of information included in this scoping review will be available to the public. Therefore, ethical review for this research is not warranted. We will disseminate our research results using multiple modes of delivery such as a peer-reviewed publication, conference presentations and stakeholder communications. Keywords: Obstetrics, patient safety, performance indicators, prevention, hospital harms, scoping review, protocol.

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Checklist para o transporte intra-hospitalar seguro do doente crítico: A scoping review

Enfermería Global ◽

10.6018/eglobal.411831 ◽

2020 ◽

Vol 19 (4) ◽

pp. 525-572

Author(s):

Madalena Canellas ◽

Isabel Palma ◽

Patrícia Pontífice-Sousa ◽

Isabel Rabiais

Keyword(s):

Patient Safety ◽

Critically Ill ◽

Scoping Review ◽

Critically Ill Patients ◽

Full Text ◽

Scientific Evidence ◽

Critically Ill Patient ◽

Intrahospital Transport ◽

Preparation Phase ◽

Critical Patients

Transportar a un paciente crítico conlleva una serie de riesgos que pueden poner en peligro su seguridad. Conocer los riesgos asociados con el transporte intrahospitalario es esencial para mejorar su seguridad. Elegimos estudiar la lista de verificación de transporte intrahospitalario, ya que la literatura los describe como una forma práctica y simple de aumentar la seguridad.Objetivo: Mapear la envidencia científica existente sobre los aspectos del check list o lista de verificación garantizando la seguridad del paciente crítico en el transporte intrahospitalario. Material y método: Se realizó un scoping review através de la metodologia The Joanna Briggs Institute, utilizando los motores de búsqueda EBSCOhost y B-on. La investigación fue realizada en portugués, inglés y español. Fueron seleccionados artículos con texto libre, sin límite de tiempo. Los criterios incluídos: el paciente crítico adulto/anciano, transporte intrahospitalario, la lista de verificación y la seguridad del paciente.Resultados: Se incluyeron 7 artículos. La mayoría de los aspectos de la lista de verificación se enfoca en la preparación del transporte, el aspecto que más se menciona es la monitorización del paciente. La parte después del transporte, aspectos de la lista de verificación solo es mencionada en 3 de los 7 artículos.Conclusión: Todos los estudios constatan aspectos que pueden incluírse en una lista de verificación y que mejoran la seguridad de los pacientes críticos en el transporte intrahospitalario. No hay unanimidad en cuanto a qué aspectos incluir en la lista de verificación. Transporting critically ill patients is has a set of risks that may jeopardize their safety. Knowing the risks associated with intrahospitalar transport of critically ill patients is essential to improving patient safety. For the sake of improving patient safety, was chosen to approach it as an intrahospitalar transport checklist, as the literature describes it as a practical and simple way to increase safety.Objective: Map available scientific evidence regarding aspects of a checklist that ensure the safety of critically ill patients in intrahospitalar transport.Material and Method: A scoping review was performed following the methodology proposed by The Joanna Briggs Institute in databases using the EBSCOhost and B-on search engines. Conducted research in Portuguese, English, and Spanish. Selected free full text articles, with no time limit. Inclusion criteria: adult/elderly critically ill patient, intrahospital transport, a checklist and patient safety.Results: Included 7 articles for analysis. Most verification requests that ensure the safety of critical patients on intrahospitalar transport concern the transport preparation phase, in which patient is monitored was the most mentioned aspect. From the post-transportation phase, checklist aspects are only available in 3 of 7 articles Conclusion: All studies address aspects that improve the safety of critically ill patients in intrahospitalar transport and are likely to be included in the checklist. There is no unanimity as to which aspects to include in the checklist. O transporte do doente crítico acarreta um conjunto de riscos para a sua segurança. Conhecer os riscos associados ao transporte intra-hospitalar do doente crítico é essencial para melhorar a segurança do mesmo. Optou-se por abordar a checklist de transporte intra-hospitalar, uma vez que a literatura a descreve como uma forma prática e simples de aumentar a segurança.Objetivo: Mapear a evidência científica disponível referente aos aspetos de uma checklist que garantem a segurança do doente crítico no transporte intra-hospitalar.Material e Método: Realizou-se uma scoping review recorrendo à metodologia do The Joanna Briggs Institute, nas bases de dados utilizando os motores de busca EBSCOhost e B-on. Realizada pesquisa em Português, Inglês e Espanhol. Selecionados artigos free full text, sem limite temporal. Critérios de inclusão: o doente crítico adulto/idoso, o transporte intra-hospitalar, a checklist e a segurança do doente.Resultados: Foram incluídos 7 artigos. A maioria dos aspetos da checklist que garantem a segurança do doente crítico no transporte intra-hospitalar, dizem respeito à fase da preparação do transporte, na qual o aspeto mais mencionado é a monitorização do doente. Da fase posterior ao transporte, aspetos da checklist apenas são mencionados em 3 dos 7 artigos.Conclusão: Todos os estudos abordam aspetos que são passíveis de incluir em checklist e melhoram a segurança do doente. Não existe unanimidade quanto aos aspetos a incluir na checklist do transporte intra-hospitalar.

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Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review

Prehospital and Disaster Medicine ◽

10.1017/s1049023x17007014 ◽

2017 ◽

Vol 33 (1) ◽

pp. 43-52 ◽

Cited By ~ 5

Author(s):

Ian Howard ◽

Peter Cameron ◽

Lee Wallis ◽

Maaret Castren ◽

Veronica Lindstrom

Keyword(s):

New York ◽

Data Collection ◽

Quality Indicators ◽

Scoping Review ◽

Emergency Care ◽

Quality Measurement ◽

Cochrane Library ◽

Prehospital Emergency Care ◽

Prehospital Emergency ◽

And Performance

AbstractIntroductionHistorically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC.ProblemQuality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature.MethodsA scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment.ResultsThe majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of all, 42.8% were categorized as primarily Clinical, with Out-of-Hospital Cardiac Arrest contributing the highest number within this domain (30.4%). Of the QIs categorized as Non-Clinical (57.2%), Time-Based Intervals contributed the greatest number (28.8%). Population on Whom the Data Collection was Constructed made up the most commonly reported QI component (79.8%), followed by a Descriptive Statement (63.6%). Least reported were Timing of Data Collection (12.1%) and Timing of Reporting (12.1%). Pilot testing of the QIs was reported on 34.7% of QIs identified in the review.ConclusionOverall, there is considerable interest in the understanding and development of PEC quality measurement. However, closer attention to the details and reporting of QIs is required for research of this type to be more easily extrapolated and generalized.HowardI, CameronP, WallisL, CastrenM, LindstromV. Quality indicators for evaluating prehospital emergency care: a scoping review. Prehosp Disaster Med. 2018;33(1):43–52.

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Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy

10.26686/wgtn.12375746.v1 ◽

2020 ◽

Author(s):

E Blix ◽

Robyn Maude ◽

E Hals ◽

S Kisa ◽

E Karlsen ◽

...

Keyword(s):

Scoping Review ◽

Meta Analysis ◽

Scientific Evidence ◽

Fetal Monitoring ◽

Low Risk ◽

Cochrane Library ◽

National Guidelines ◽

Creative Commons ◽

Active Labour ◽

Randomised Controlled

© 2019 Blix et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Intermittent auscultation (IA) is the technique of listening to and counting the fetal heart rate (FHR) for short periods during active labour and continuous cardiotocography (CTC) implies FHR monitoring for longer periods. Although the evidence suggests that IA is the best way to monitor healthy women at low risk of complications, there is no scientific evidence for the ideal device, timing, frequency and duration for IA. We aimed to give an overview of the field, identify and describe methods and practices for performing IA, map the evidence and accuracy for different methods of IA, and identify research gaps. Methods We conducted a systematic scoping review following the Joanna Briggs methodology. Med-line, EMBASE, Cinahl, Maternity & Infant Care, Cochrane Library, SveMed+, Web of Science, Scopus, Lilacs and African Journals Online were searched for publications up to January 2019. We did hand searches in relevant articles and databases. Studies from all countries, international guidelines and national guidelines from Denmark, United Kingdom, United States, New Zealand, Australia, The Netherlands, Sweden, Denmark, and Norway were included. We did quality assessment of the guidelines according to the AGREEMENT tool. We performed a meta-analysis assessing the effects of IA with a Doppler device vs. Pinard device using methods described in The Cochrane Handbook, and we performed an overall assessment of the summary of evidence using the GRADE approach. Results The searches generated 6408 hits of which 26 studies and 11 guidelines were included in the review. The studies described slightly different techniques for performing IA, and some did not provide detailed descriptions. Few of the studies provided details of normal and abnormal IA findings. All 11 guidelines recommended IA for low risk women, although they had slightly different recommendations on the frequency, timing, and duration for IA, and the FHR characteristics that should be observed. Four of the included studies, comprising 8436 women and their babies, were randomised controlled trials that evaluated the effect of IA with a Doppler device vs. a Pinard device. Abnormal FHRs were detected more often using the Doppler device than in those using the Pinard device (risk ratio 1.77; 95% confidence interval 1.29–2.43). There were no significant differences in any of the other maternal or neonatal outcomes. Four studies assessed the accuracy of IA findings. Normal FHR was easiest to identify correctly, whereas identifying periodic FHR patterns such as decelerations and saltatory patterns were more difficult. Conclusion Although IA is the recommended method, no trials have been published that evaluate protocols on how to perform it. Nor has any study assessed interrater agreements regarding interpretations of IA findings, and few have assessed to what degree clinicians can describe FHR patterns detected by IA. We found no evidence to recommend Doppler device instead of the Pinard for IA, or vice versa.

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