Measures Of Resource Use Research Articles

Consequences of delaying non-urgent surgeries during COVID-19: a population-based retrospective cohort study in Alberta, Canada

ObjectivesTo ensure sufficient resources to care for patients with COVID-19, healthcare systems delayed non-urgent surgeries to free capacity. This study explores the consequences of delaying non-urgent surgery on surgical care...

A palliative care approach for adult non-cancer patients with life-limiting illnesses is cost-saving or cost-neutral: a systematic review of RCTs

BackgroundPatients living with life-limiting illnesses other than cancer constitute the majority of patients in need of palliative care globally, yet most previous systematic reviews of the cost impact of palliative care have not exclusively focused on this population. Reviews that tangentially looked at non-cancer patients found inconclusive evidence. Randomised controlled trials (RCTs) are the gold standard for treatment efficacy, while total health care costs offer a comprehensive measure of resource use. In the sole review of RCTs for non-cancer patients, palliative care reduced hospitalisations and emergency department visits but its effect on total health care costs was not assessed. The aim of this study is to review RCTs to determine the difference in costs between a palliative care approach and usual care in adult non-cancer patients with a life-limiting illness.MethodsA systematic review using a narrative synthesis approach. The protocol was registered with PROSPERO prospectively (no. CRD42020191082). Eight databases were searched: Medline, CINAHL, EconLit, EMBASE, TRIP database, NHS Evidence, Cochrane Library, and Web of Science from inception to January 2023. Inclusion criteria were: English or German; randomised controlled trials (RCTs); adult non-cancer patients (> 18 years); palliative care provision; a comparator group of standard or usual care. Quality of studies was assessed using Drummond’s checklist for assessing economic evaluations.ResultsSeven RCTs were included and examined the following diseases: neurological (3), heart failure (2), AIDS (1) and mixed (1). The majority (6/7) were home-based interventions. All studies were either cost-saving (3/7) or cost-neutral (4/7); and four had improved outcomes for patients or carers and three no change in outcomes.ConclusionsIn a non-cancer population, this is the first systematic review of RCTs that has demonstrated a palliative care approach is cost-saving or at least cost-neutral. Cost savings are achieved without worsening outcomes for patients and carers. These findings lend support to calls to increase palliative care provision globally.

Identification and prioritisation of items for a draft participant-reported questionnaire to measure use of social care, informal care, aids and adaptations.

Resource-use measurement is integral for assessing cost-effectiveness within trial-based economic evaluations. Methods for gathering resource-use data from participants are not well developed, with questionnaires typically produced for each trial and rarely validated. The healthcare module of a generic, modular resource-use measure, designed for collecting self-report resource-utilisation data, has recently been developed in the UK. The objective of this research is to identify and prioritise items for new, bolt-on modules, covering informal care, social care and personal expenses incurred due to health and care needs. Identification and prioritisation, conducted between April and December 2021, involved a rapid review of questionnaires included in the Database of Instruments for Resource Use Measurement and economic evaluations published from 2011 to 2021 to identify candidate items, an online survey of UK-based social care professionals to identify omitted social care items and focus groups with UK-based health economists and UK-based people who access social care services either for themselves or as carers to prioritise items. The review identified 203 items. Over half of the 24 survey respondents reported no missing items. Five academic health economists and four people who access social care services participated in focus groups. Feedback shaped the social and informal care modules and indicated that no specific personal expenses were essential to collect in all trials. Aids/adaptations were highlighted as costly personal expenses when relevant; therefore, the personal expenses module was narrowed to aids/adaptations only. Draft informal care, social care and aids/adaptations modules were developed, ready for further testing.

The Effects of Light Spectrum and Intensity, Seeding Density, and Fertilization on Biomass, Morphology, and Resource Use Efficiency in Three Species of Brassicaceae Microgreens.

Light is a critical component of indoor plant cultivation, as different wavelengths can influence both the physiology and morphology of plants. Furthermore, fertilization and seeding density can also potentially interact with the light recipe to affect production outcomes. However, maximizing production is an ongoing research topic, and it is often divested from resource use efficiencies. In this study, three species of microgreens-kohlrabi; mustard; and radish-were grown under five light recipes; with and without fertilizer; and at two seeding densities. We found that the different light recipes had significant effects on biomass accumulation. More specifically, we found that Far-Red light was significantly positively associated with biomass accumulation, as well as improvements in height, leaf area, and leaf weight. We also found a less strong but positive correlation with increasing amounts of Green light and biomass. Red light was negatively associated with biomass accumulation, and Blue light showed a concave downward response. We found that fertilizer improved biomass by a factor of 1.60 across species and that using a high seeding density was 37% more spatially productive. Overall, we found that it was primarily the main effects that explained microgreen production variation, and there were very few instances of significant interactions between light recipe, fertilization, and seeding density. To contextualize the cost of producing these microgreens, we also measured resource use efficiencies and found that the cheaper 24-volt LEDs at a high seeding density with fertilizer were the most efficient production environment for biomass. Therefore, this study has shown that, even with a short growing period of only four days, there was a significant influence of light recipe, fertilization, and seeding density that can change morphology, biomass accumulation, and resource input costs.

Development of a resource-use measure to capture costs of diabetic foot ulcers to the United Kingdom National Health Service, patients and society.

Diabetic foot ulcers (DFUs) add a significant burden to the lives of people with diabetes in the United Kingdom. They can have a considerable impact on a patient's daily life, with treatment requiring frequent changes of dressings and clinic attendances. Nurses and other allied health professionals (AHPs) within the community provide most wound care representing the primary cost driver. To collaboratively explore key resource use related to the management of DFUs to develop, and pilot, a participant-reported measure to inform economic evaluations. A literature search and semi-structured interviews determined health and non-health resource use in management of DFUs. A consensus view of the selected items was established in a modified Delphi study and further tested for acceptability and validity in a pilot study. Primary care consultations with a podiatrist or orthotist, district nurse visits, out-of-hours and emergency care, scans and investigations, and consumables provided in clinics were rated as the most important resource use items. This work has informed the development of a measure that captures resource use considered important by the people most affected by DFUs; patients, family members and carers, and the healthcare professionals key to DFU management.

Commentary: Development of a resource-use measure to capture costs of diabetic foot ulcers to the United Kingdom National Health Service, patients and society.

Commentary: Development of a resource-use measure to capture costs of diabetic foot ulcers to the United Kingdom National Health Service, patients and society.

The identification of economically relevant health and social care services for mental disorders in the PECUNIA project

BackgroundHealth economic research is still facing significant problems regarding the standardization and international comparability of health care services. As a result, comparative effectiveness studies and cost-effectiveness analyses are often not comparable. This study is part of the PECUNIA project, which aimed to improve the comparability of economic evaluations by developing instruments for the internationally standardized measurement and valuation of health care services for mental disorders. The aim of this study was to identify internationally relevant services in the health and social care sectors relevant for health economic studies for mental disorders.MethodsA systematic literature review on cost-of-illness studies and economic evaluations was conducted to identify relevant services, complemented by an additional grey literature search and a search of resource use measurement (RUM) questionnaires. A preliminary long-list of identified services was explored and reduced to a short-list by multiple consolidation rounds within the international research team and an external international expert survey in six European countries.ResultsAfter duplicate removal, the systematic search yielded 15,218 hits. From these 295 potential services could be identified. The grey literature search led to 368 and the RUM search to 36 additional potential services. The consolidation process resulted in a preliminary list of 186 health and social care services which underwent an external expert survey. A final consolidation step led to a basic list of 56 services grouped into residential care, daycare, outpatient care, information for care, accessibility to care, and self-help and voluntary care.ConclusionsThe initial literature searches led to an extensive number of potential service items for health and social care. Many of these items turned out to be procedures, interventions or providing professionals rather than services and were removed from further analysis. The resulting list was used as a basis for typological coding, the development of RUM questionnaires and corresponding unit costs for international mental health economic studies in the PECUNIA project.

Development of a brief, generic, modular resource-use measure (ModRUM): piloting with patients

BackgroundBespoke self-report resource-use measures (RUMs) are commonly developed or adapted for each new randomised controlled trial. Consequently, RUMs lack standardisation and validation is rarely conducted. A new generic RUM, ModRUM, has been developed using a rigorous process, including consultation with health economists and patients. ModRUM includes a concise core healthcare module, designed to be included in all trials, and depth-adding questions, which can replace or be added to core questions as needed. Modules covering other sectors are under development. The aim of this study was to test the acceptability, feasibility, and criterion and construct validity of the healthcare module of ModRUM.MethodsPatients who had a recent appointment at their GP practice were invited to complete ModRUM (core module or core module with depth questions), a characteristics form and the EQ-5D-5L. Acceptability was assessed via response rates and questionnaire completion time. Feasibility was assessed by reviewing issues observed in participants’ responses and question completion rates. Construct validity was tested via hypothesis testing and known-group analyses, using Wilcoxon rank-sum and Kruskal–Wallis tests, and a generalised linear model. Criterion validity was tested by comparing ModRUM results with primary care medical records. Sensitivity, specificity, and agreement using Lin’s concordance correlation coefficient (pc) were estimated.ResultsOne hundred patients participated from five GP practices in the South-West of England. Acceptability was higher for the core module (20% versus 10% response rate). Question completion rates were high across both versions (> 90%). Some support was observed for construct validity, with results suggesting that healthcare costs differ dependent on the number of long-term conditions (p < 0.05) and are negatively associated with health-related quality of life (p < 0.01). Sensitivity was high for all questions (> 0.83), while specificity varied (0.33–0.88). There was a good level of agreement for GP contacts and costs, and prescribed medication costs (pc > 0.6).ConclusionThis study provided preliminary evidence of the acceptability, feasibility, and criterion and construct validity of ModRUM. Further testing is required within trials and with groups that were less well represented in this study.

Does Living in a Protected Area Reduce Resource Use and Promote Life Satisfaction? Survey Results from and Around Three Regional Nature Parks in Switzerland

Regional nature parks in Switzerland are, for the most part, protected areas that aim to promote sustainable development and residents’ well-being. In recent years, research on regional nature parks and comparable protected areas has focused on questions regarding local populations’ acceptance of such areas, their governance, and their economic effects. However, we know surprisingly little about the impact of protected areas on environmental resource use and life satisfaction, two essential ingredients of sustainable regional development. In this study, we survey people living in and around three regional nature parks in Switzerland on their resource use and life satisfaction (gross sample n = 3358). We propose a novel measurement of resource use based on vignettes describing different lifestyles, which we validate against the carbon footprint obtained for a subsample of our respondents. With these indicators, using multiple regression analyses, we test several hypotheses derived from the literature on the relationship between resource use and life satisfaction in and around protected areas. Contrary to our expectations, we do not find differences in resource use or life satisfaction, or the relationship between resource use and life satisfaction, across park and non-park regions. We discuss potential explanations for our findings and their implications for nature park authorities and future study designs.

The Zone Overlap Index: A new measure of shared resource use in the zoo.

It is important that the environment provided in the zoo is relevant to the species being housed and its suitability be easily assessed by personnel. As shared space and resources can overlap in a zoo's enclosure a tool is required to measure the effects of such overlap between individual animals in a shared enclosure. This paper outlines the Pianka Index (PI), a tool used in ecology to quantify niche overlap, that has value in quantifying the amount of time that animals spend in shared enclosure zones. One limitation to this method, however, is that the established method of determining the PI requires division of the enclosure into equally sized zones, something that is not always relevant to a zoo enclosure. To combat this, we created a modified index, entitled the Zone Overlap Index (ZOI). This modified index is the exact mathematical equivalent of the original index when zone sizes are equal. When zone sizes are unequal, the ZOI generates higher values when animals share smaller, as opposed to larger, zones. This is because animals are more likely to share larger enclosure zones simply by chance, and shared use of smaller zones brings individuals into closer proximity with the potential for competition. To illustrate the application of the ZOI, a series of hypothetical situations were generated to reflect real-world scenarios, demonstrating how this index could be used to better understand zone occupancy overlap in the zoo.

Economic Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Low Surgical Risk: Results from the PARTNER 3 Trial.

In patients with severe symptomatic aortic stenosis at low surgical risk, transfemoral transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve has been shown to reduce the composite of death, stroke, or rehospitalization at 2-year follow-up compared with surgical aortic valve replacement (SAVR). Whether TAVR is cost-effective compared with SAVR for low-risk patients remains uncertain. Between 2016 and 2017, 1000 low-risk patients with aortic stenosis were randomly assigned to TAVR with the SAPIEN 3 valve or SAVR in the PARTNER 3 trial (Placement of Aortic Transcatheter Valves). Of these patients, 929 underwent valve replacement, were enrolled in the United States, and were included in the economic substudy. Procedural costs were estimated using measured resource use. Other costs were determined by linkage with Medicare claims or by regression models when linkage was not feasible. Health utilities were estimated using the EuroQOL 5-item questionnaire. With the use of a Markov model informed by in-trial data, lifetime cost-effectiveness from the perspective of the US health care system was estimated in terms of cost per quality-adjusted life-year gained. Although procedural costs were nearly $19 000 higher with TAVR, total index hospitalization costs were only $591 more with TAVR compared with SAVR. Follow-up costs were lower with TAVR such that TAVR led to 2-year cost savings of $2030/patient compared with SAVR (95% CI, -$6222 to $1816) and a gain of 0.05 quality-adjusted life-years (95% CI, -0.003 to 0.102). In our base-case analysis, TAVR was projected to be an economically dominant strategy with a 95% probability that the incremental cost-effectiveness ratio for TAVR would be <$50 000/quality-adjusted life-year gained (consistent with high economic value from a US health care perspective). These findings were sensitive to differences in long-term survival, however, such that a modest long-term survival advantage with SAVR would render SAVR cost-effective (although not cost saving) compared with TAVR. For patients with severe aortic stenosis and low surgical risk similar to those enrolled in the PARTNER 3 trial, transfemoral TAVR with the SAPIEN 3 valve is cost saving compared with SAVR at 2 years and is projected to be economically attractive in the long run as long as there are no substantial differences in late death between the 2 strategies. Long-term follow-up will be critical to ultimately determine the preferred treatment strategy for low-risk patients from both a clinical and economic perspective.

Methods for think-aloud interviews in health-related resource-use research: the PECUNIA RUM instrument

Background The think-aloud (TA) approach is a qualitative research method that allows for gaining insight in thoughts and cognitive processes. It can be used to incorporate a respondent’s perspective when developing resource-use measurement (RUM) instruments. Currently, the application of TA methods in RUM research is limited, and so is the guidance on how to use them. Transparent publication of TA methods for RUM in health economics studies, which is the aim of this paper, can contribute to reducing the aforementioned gap. Methods Methods for conducting TA interviews were iteratively developed by a multi-national working group of health economists and additional qualitative research expertise was sought. TA interviews were conducted in four countries to support this process. A ten-step process was outlined in three parts: Part A ‘before the interview’ (including translation, recruitment, training), Part B ‘during the interview’ (including setting, opening, completing the instrument, open-ended questions, closing), and part C ‘after the interview’ (including transcription and data analysis, trustworthiness). Conclusions This manuscript describes the step-by-step approach for conducting multi-national TA interviews with potential respondents of the PECUNIA RUM instrument. It increases the methodological transparency in RUM development and reduces the knowledge gap of using qualitative research methods in health economics.

Excess healthcare costs of mental disorders in children, adolescents and young adults in the Basque population registry adjusted for socioeconomic status and sex

BackgroundMental illnesses account for a considerable proportion of the global burden of disease. Economic evaluation of public policies and interventions aimed at mental health is crucial to inform decisions and improve the provision of healthcare services, but experts highlight that nowadays the cost implications of mental illness are not properly quantified. The objective was to measure the costs of excess use of all healthcare services by 1- to 30-year-olds in the Basque population as a function of whether or not they had a mental disorder diagnosis.MethodsA real-world data study was used to identify diagnoses of mental disorders and to measure resource use in the Basque Health Service Registry in 2018. Diagnoses were aggregated into eight diagnostic clusters: anxiety, attention deficit hyperactivity disorder, conduct disorders, mood disorders, substance use, psychosis and personality disorders, eating disorders, and self-harm. We calculated the costs incurred by each individual by multiplying the resource use by the unit costs. Annual costs for each cluster were compared with those for individuals with no diagnosed mental disorders through entropy balancing and two-part models which adjusted for socioeconomic status (SES).ResultsOf the 609,381 individuals included, 96,671 (15.9%) had ≥ 1 mental disorder diagnosis. The annual cost per person was two-fold higher in the group diagnosed with mental disorders (€699.7) than that with no diagnoses (€274.6). For all clusters, annual excess costs associated with mental disorders were significant. The adjustment also evidenced a social gradient in healthcare costs, individuals with lower SES consuming more resources than those with medium and higher SES across all clusters. Nonetheless, the effect of being diagnosed with a mental disorder had a greater impact on the mean and excess costs than SES.ConclusionsResults were consistent in showing that young people with mental disorders place a greater burden on healthcare services. Excess costs were higher for severe mental disorders like self-harm and psychoses, and lower SES individuals incurred, overall, more than twice the costs per person with no diagnoses. A socioeconomic gradient was notable, excess costs being higher in low SES individuals than those with a high-to-medium SES. Differences by sex were also statistically significant but their sizes were smaller than those related to SES.

Productivity and Efficiency of Community Gardens: Case Studies from the UK

The extensive and burgeoning literature on the productivity of urban farms and gardens is largely focused on measures of crop yield and resource use, with little offered to date on their contribution to social productivity and sustainability. This paper suggests that evaluation of urban agriculture should consider all types of resource consumption and productivity simultaneously. The research reported here used a citizen science approach to collect data from seven community gardens and one community farm in London, UK in the 2019 and 2020 growing seasons. The paper examines the many variables that impact the sites’ overall performance, highlighting the complex nature and relationship between the many benefits and outcomes of urban farms and gardens. Data are presented on crop yield, equivalent fruit and vegetable portions, input use (including water and fertilizer), journeys made to the garden by volunteers, social benefits, and social outreach. Results show very mixed levels of crop and social productivity, depending on the organizational structure and agenda of the various sites included in the study. With no clear pattern emerging, this paper suggests that the evaluation of citywide productivity, often based on projections of small data samples, may not be reliable. By ensuring that training opportunities for volunteers are made available, higher resource efficiency as well as higher productivity could be attained.

Development of an Instrument for the Assessment of Health-Related Multi-sectoral Resource Use in Europe: The PECUNIA RUM.

Measuring objective resource-use quantities is important for generating valid cost estimates in economic evaluations. In the absence of acknowledged guidelines, measurement methods are often chosen based on practicality rather than methodological evidence. Furthermore, few resource-use measurement (RUM) instruments focus on the measurement of resource use in multiple societal sectors and their development process is rarely described. Thorn and colleagues proposed a stepwise approach to the development of RUM instruments, which has been used for developing cost questionnaires for specific trials. However, it remains unclear how this approach can be translated into practice and whether it is applicable to the development of generic self-reported RUM instruments and instruments measuring resource use in multiple sectors. This study provides a detailed description of the practical application of this stepwise approach to the development of a multi-sectoral RUM instrument developed within the ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) project. For the development of the PECUNIA RUM, the methodological approach was based on best practice guidelines. The process included six steps, including the definition of the instrument attributes, identification of cost-driving elements in each sector, review of methodological literature and development of a harmonized cross-sectorial approach, development of questionnaire modules and their subsequent harmonization. The selected development approach was, overall, applicable to the development of the PECUNIA RUM. However, due to the complexity of the development of a multi-sectoral RUM instrument, additional steps such as establishing a uniform methodological basis, harmonization of questionnaire modules and involvement of a broader range of stakeholders (healthcare professionals, sector-specific experts, health economists) were needed. This is the first study that transparently describes the development process of a generic multi-sectoral RUM instrument in health economics and provides insights into the methodological aspects and overall validity of its development process.

Overcoming poverty traps in Mozambique: Quantifying inequalities among economic, social and environmental capitals

Assessing sustainable development strategies and alternatives depends on placing human well-being and the environment at the core of policy efforts and developing accounting methods to determine whether countries are progressing towards increasingly equal well-being. In this work, emergy accounting was used within the five-sector sustainability model (5SenSu) for measuring resource use inequality. As a diagnostic proposal, the 5SEnSU model based on the theory of ecologically unequal exchanges and emergy synthesis were used to assess Mozambique's poverty traps. Inequalities were measured considering the flows of goods, energy, and money between the social, economic, and environmental sectors as representative of the national economy. The 5SEnSU model showed that the environment directly supports a large part of the Mozambican population and that the country has growth potential according to the natural environment over 38 sej/sej, which must be used to ensure sustainable and equitable growth. Mozambique also has the potential (23:1 in emergy units) to maintain carbon neutrality and preserve forests and soil resources while undergoing economic development and growth. Mozambique has carbon credit and a resource surplus but needs to develop mechanisms to improve economic sectors through cleaner and well-being-centered development policies. High inequality between the social sectors and the economic system exposed a high dependency on local environmental resources characterizing a condition of vulnerability. The reduction in the number of people living below the poverty line and the effective implementation of the sustainable development goals may be achieved by balancing the capacity of the economic system with the country's environmental/social capacitiy.

Development and delivery cost of digital health technologies for mental health: Application to the Narrative Experiences Online Intervention

The increasing development and use of digital health interventions requires good quality costing information to inform development and commissioning choices about resource allocation decisions. The Narrative Experiences Online (NEON) Intervention is a web-application that delivers recorded mental health recovery narratives to its users. Two randomized controlled trials are testing the NEON Intervention in people with experience of psychosis (NEON) and people experiencing non-psychosis mental health problems (NEON-O). This study describes and estimates the cost components and total cost of developing and delivering the NEON Intervention. Total costs for the NEON Trial (739 participants) and NEON-O Trial (1,024 participants) were estimated by: identifying resource use categories involved in intervention development and delivery; accurate measurement or estimation of resource use; and a valuation of resource use to generate overall costs, using relevant unit costs. Resource use categories were identified through consultation with literature, costing reporting standards and iterative consultation with health researchers involved in NEON Intervention development and delivery. Sensitivity analysis was used to test assumptions made. The total cost of developing the NEON Intervention was £182,851. The largest cost components were software development (27%); Lived Experience Advisory Panel workshops (23%); coding the narratives (9%); and researchers' time to source narratives (9%). The total cost of NEON Intervention delivery during the NEON Trial was £118,663 (£349 per NEON Intervention user). In the NEON-O Trial, the total delivery cost of the NEON Intervention was £123,444 (£241 per NEON Intervention user). The largest cost components include updating the narrative collection (50%); advertising (19%); administration (14%); and software maintenance (11%). Uncertainty in the cost of administration had the largest effect on delivery cost estimates. Our work shows that developing and delivering a digital health intervention requires expertise and time commitment from a range of personnel. Teams developing digital narrative interventions need to allocate substantial resources to curating narrative collections. This study identifies the development and delivery resource use categories of a digital health intervention to promote the consistent reporting of costs and informs future decision-making about the costs of delivering the NEON Intervention at scale. NEON Trial: ISRCTN11152837, registered 13 August 2018, http://www.isrctn.com/ISRCTN11152837. NEON-O Trial: ISRCTN63197153, registered 9 January 2020, http://www.isrctn.com/ISRCTN63197153.

Seeing is caring – automated assessment of resource use of broilers with computer vision techniques

Routine monitoring of broiler chickens provides insights in the welfare status of a flock, helps to guarantee minimum defined levels of animal welfare and assists farmers in taking remedial measures at an early stage. Computer vision techniques offer exciting potential for routine and automated assessment of broiler welfare, providing an objective and biosecure alternative to the current more subjective and time-consuming methods. However, the current state-of-the-art computer vision solutions for assessing broiler welfare are not sufficient to allow the transition to fully automated monitoring in a commercial environment. Therefore, the aim of this study was to investigate the potential of computer vision algorithms for detection and resource use monitoring of broilers housed in both experimental and commercial settings, while also assessing the potential for scalability and resource-efficient implementation of such solutions. This study used a combination of detection and resource use monitoring methods, where broilers were first detected using Mask R-CNN and were then assigned to a specific resource zone using zone-based classifiers. Three detection models were proposed using different annotation datasets: model A with annotated broilers from a research facility, model B with annotated broilers from a commercial farm, and model A+B where annotations from both environments were combined. The algorithms developed for individual broiler detection performed well for both the research facility (model A, F1 score &amp;gt; 0.99) and commercial farm (model A+B, F1 score &amp;gt; 0.83) test data with an intersection over union of 0.75. The subsequent monitoring of resource use at the commercial farm using model A+B for broiler detection, also performed very well for the feeders, bale and perch (F1 score &amp;gt; 0.93), but not for the drinkers (F1 score = 0.28), which was likely caused by our evaluation method. Thus, the algorithms used in this study are a first step to measure resource use automatically in commercial application and allow detection of a large number of individual animals in a non-invasive manner. From location data of every frame, resource use can be calculated. Ultimately, the broiler detection and resource use monitoring might further be used to assess broiler welfare.

Outcomes in intervention research on snakebite envenomation: a systematic review

Introduction: A core outcome set (COS) is a minimal list of consensus outcomes that should be used in all intervention research in a specific domain. COS enhance the ability to undertake meaningful comparisons and to understand the benefits or harms of different treatments. A first step in developing a COS is to identify outcomes that have been used previously. We did this global systematic review to provide the foundation for development of a region-specific COS for snakebite envenomation. Methods: We searched 15 electronic databases, eight trial registries, and reference lists of included studies to identify reports of relevant trials, protocols, registry records and systematic reviews. We extracted verbatim data on outcomes, their definitions, measures, and time-points. Outcomes were classified as per an existing outcome taxonomy, and we identified unique outcomes based on similarities in the definition and measurement of the verbatim outcomes. Results: We included 107 records for 97 studies which met our inclusion criteria. These reported 538 outcomes, with a wide variety of outcome measures, definitions, and time points for measurement. We consolidated these into 88 unique outcomes, which we classified into core areas of mortality (1, 1.14 %), life impact (6, 6.82%), resource use (15, 17.05%), adverse events (7, 7.95%), physiological/clinical (51, 57.95%), and composite (8, 9.09%) outcomes. The types of outcomes varied by the type of intervention, and by geographic region. Only 15 of the 97 trials (17.04%) listed Patient Related Outcome Measures (PROMS). Conclusion: Trials evaluating interventions for snakebite demonstrate heterogeneity on outcomes and often omit important information related to outcome measurement (definitions, instruments, and time points). Developing high quality, region-specific COS for snakebite could inform the design of future trials and improve outcome reporting. Measurement of PROMS, resource use and life impact outcomes in trials on snakebite remains a gap.

Mechanism of injury and special considerations as predictive of serious injury: A systematic review.

ObjectivesThe Centers for Disease Control and Prevention's field triage guidelines (FTG) are routinely used by emergency medical services personnel for triaging injured patients. The most recent (2011) FTG contains physiologic, anatomic, mechanism, and special consideration steps. Our objective was to systematically review the criteria in the mechanism and special consideration steps that might be predictive of serious injury or need for a trauma center.MethodsWe conducted a systematic review of the predictive utility of mechanism and special consideration criteria for predicting serious injury. A research librarian searched in Ovid Medline, EMBASE, and the Cochrane databases for studies published between January 2011 and February 2021. Eligible studies were identified using a priori inclusion and exclusion criteria. Studies were excluded if they lacked an outcome for serious injury, such as measures of resource use, injury severity scores, mortality, or composite measures using a combination of outcomes. Given the heterogeneity in populations, measures, and outcomes, results were synthesized qualitatively focusing on positive likelihood ratios (LR+) whenever these could be calculated from presented data or adjusted odds ratios (aOR).ResultsWe reviewed 2418 abstracts and 315 full‐text publications and identified 42 relevant studies. The factors most predictive of serious injury across multiple studies were death in the same vehicle (LR+ 2.2–7.4), ejection (aOR 3.2–266.2), extrication (LR+ 1.1–6.6), lack of seat belt use (aOR 4.4–11.3), high speeds (aOR 2.0–2.9), concerning crash variables identified by vehicle telemetry systems (LR+ 4.7–22.2), falls from height (LR+ 2.4–5.9), and axial load or diving (aOR 2.5–17.6). Minor or inconsistent predictors of serious injury were vehicle intrusion (LR+ 0.8–7.2), cardiopulmonary or neurologic comorbidities (LR+ 0.8–3.1), older age (LR+ 0.6–6.8), or anticoagulant use (LR+ 1.1–1.8).ConclusionsSelect mechanism and special consideration criteria contribute positively to appropriate field triage of potentially injured patients.