The healthcare professionals' perspectives and experiences with family presence during resuscitation: A qualitative evidence synthesis.

INTRODUCTION: Family presence during resuscitation (FPDR) is a growing hospital praxis despite lack of high-quality evidence. The aim of this qualitative evidence synthesis review was to synthesize current evidence regarding healthcare professionals (HCP) perspectives on barriers and facilitating factors of FPDR and the potential impact of FPDR on HCP performance. METHODS: We conducted a systematic literature search May 17, 2023 including primary studies with qualitative study designs. We applied NVivo for data analysis. Data was coded with line-by-line coding and organized into themes and categories following the method for thematic synthesis described by Thomas and Harden to analyse data. The studies underwent quality appraisal by Critical Appraisal Skills Program. We used GRADE CERQual to assess the confidence in the evidence. RESULTS: We identified 8241 articles suitable for screening, 141 articles were full text screened, and nine studies included from Australia, UK and USA. In total, 134 HCP participated, between 2005 and 2019. Most studies lacked sufficiently rigorous data analysis and findings were appraised to have moderate GRADE CERQual confidence. We identified three analytical themes ("Facilitating factors for FPDR", "Barriers for FPDR" and "How staff are affected by FPDR") with eight descriptive subthemes. One finding was of high GRADE CERQual confidence: a belief that FPDR is "the right thing to do" which was a "Facilitating factor of FPDR." CONCLUSION: The evidence on HCP perspectives is of low to moderate confidence. The interviewed consent that FPDR is the "right thing to do", and an ethical principle of beneficence is dominant, especially regarding children.

Pre-operative epidural analgesia in hip fracture patients - A systematic review and meta-analysis.

BACKGROUND: Hip fracture is a common, painful injury with increasing global incidence. Patients require optimal acute pain management. Systematic reviews have investigated the postoperative use of epidural analgesia and found that it may have advantages over systemic analgesia. It is of interest to determine whether pre-operative use of epidural analgesia is also advantageous. We conducted a systematic review and meta-analyses on the effect of epidural analgesia on pre-operative pain management in hip fracture patients. METHODS: We included randomized controlled trials comparing pre-operatively initiated epidural analgesia with any other method of analgesia, in adults aged ≥55 years scheduled for hip fracture surgery. The main outcome was pre-operative pain at rest. Electronic searches of four medical databases were performed. Two authors independently screened for eligibility, extracted data, and assessed risk of bias. We conducted meta-analyses and assessed the certainty of the evidence by Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Three articles were included, with 179 randomized patients. All studies compared epidural analgesia with systemic analgesia, one additionally with 3-in-1-block. Meta-analyses of pre-operative pain measurements resulted in a mean difference of -5.85 95% CI [-14.90; 3.19] on a 0-100 Visual Analogue Scale with a p-value of 0.17 and a very low certainty of evidence according to the GRADE rating. CONCLUSIONS: We did not find a difference in pre-operative pain at rest between epidural analgesia and any other method of pre-operatively initiated analgesia. The studies were few, of low quality and the difference between the two interventions remains unknown.

New clinical guidelines on the spinal stabilisation of adult trauma patients - consensus and evidence based.

Traumatic spinal cord injury is a relatively rare injury in Denmark but may result in serious neurological consequences. For decades, prehospital spinal stabilisation with a rigid cervical collar and a hard backboard has been considered to be the most appropriate procedure to prevent secondary spinal cord injuries during patient transportation. However, the procedure has been questioned in recent years, due to the lack of high-quality studies supporting its efficacy. A national interdisciplinary task force was therefore established to provide updated clinical guidelines on prehospital procedures for spinal stabilisation of adult trauma patients in Denmark. The guidelines are based on a systematic review of the literature and grading of the evidence, in addition to a standardised consensus process.This process yielded five main recommendations:A strong recommendation against spinal stabilisation of patients with isolated penetrating trauma; a weak recommendation against the prehospital use of a rigid cervical collar and a hard backboard for ABCDE-stable patients; and a weak recommendation for the use of a vacuum mattress for patient transportation. Finally, our group recommends the use of our clinical algorithm to ensure good clinical practice.