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Objective To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH).Design Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial.Setting UK secondary care.Participants 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122).Interventions Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery).Main outcome measures In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists.Results In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be −£5520 (95% CI −£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be −£4536 (95% CI −£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE.Conclusions In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant).Ethics Ethical approval for the trial was obtained from the North West—Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076).Trial registration number ISRCTN87370545.

Background: Sedation is used alongside mechanical ventilation for patients in intensive care units internationally; its use is complex and multifaceted. Existing evidence shows that the ways health care professionals use sedation significantly impacts patient outcomes, including how long someone spends on a ventilator, length of stay in intensive care and recovery. Objective: Our study aimed to systematically review and synthesize qualitative and quantitative evidence about how intensive care staff perceive sedation practices when looking after sedated and mechanically ventilated patients. Design: We performed a systematic integrated mixed-methods literature review collecting qualitative and quantitative studies according to inclusion and exclusion criteria. Studies were included if they were published from 2009 and focused on perceptions of staff working in general adult intensive care units and caring for mechanically ventilated patients. Setting(s): General adult intensive care units. Participants: Health care professionals working in adult intensive care units. Methods: Screening, data extraction and quality appraisal was undertaken by SV. Screening for inclusion and quality issues were reviewed by TR, TM and JS. The following databases: Embase, BNI, PubMed, Scopus, AMED, CINAHL, ASSIA, The Cochrane Library and Google Scholar. We used an assessment tool called the Mixed Methods Appraisal Tool. The studies were assessed and analysed by transforming the qualitative and quantitative data into 'text-in-context' statements. The statements were then synthesized using thematic analysis. Results: Eighteen studies were included from ten countries, fourteen quantitative and four qualitative. Three overarching themes were identified: 'Variation in Decision Making', 'Challenges in Decision Making' and 'Thinking Outside the Box'. Existing studies revealed that there is considerable variation in most aspects of perceived sedation practice. Staff face challenges with interprofessional collaboration and sedation practice, and there are barriers to using sedation protocols and light sedation. There is also evidence that there is a need for health care professionals to develop coping strategies to help them facilitate lighter sedation. Conclusions: A review of a decade of evidence shows that variation in decision making and challenges in decision making should be addressed to improve the care of the sedated and ventilated patient, and improve the caregiving experience for staff. Staff continue to require support with sedation practice, especially in light sedation. Research should now focus on how to help staff cope with looking after lightly sedated patients. In addition, future studies should focus on exploring sedation practices using qualitative methods as there is a dearth of qualitative evidence. Tweetable abstract: Staff perceive a range of complex challenges that explain some of the variability in sedation practice for the ventilated patient in ICU.

Context. Nest boxes are a useful tool in the reintroduction, conservation and monitoring of many hollow-using species. Aims. All forms of nest-box monitoring involve some form of invasion, often upsetting their continued use by occupants. We conducted a pilot study to investigate and validate the innovative use of temperature dataloggers (iButtons®) to remotely monitor nest-box use, leaving the nest-box occupants untouched. Methods. In captivity, iButton recordings revealed the duration and time of day when each of the three nest-box designs was occupied by Pseudocheirus occidentalis(western ringtail possums); the accuracy of occupancy data was validated by unobtrusive infrared video recording. In the field, where translocated P. occidentalisand naturally occurring Trichosurus vulpecula(common brushtail possum) populations are present, hair sampling at the nest-box entrances (in addition to iButton recording) was used to identify the mammal species present. Key results. Nest-box use by captive P. occidentalisvalidated iButtons as a useful remote-monitoring tool, with 10h) periods of continuous occupancy (T. vulpeculaonly). In addition to the convenience (to researcher and animal) of continuous (24-h) monitoring with minimal disturbance, a major advantage from using iButtons is that occupancy can be matched with environmental temperature or rainfall records, as well as other events (e.g. storms or frost). Conclusions. iButtons are a useful remote-monitoring tool of nest boxes, and it is possible that their use in this manner may be extended to tree-hollow occupation. Most importantly, this approach can inform us as to the conditions under which the nest boxes are used by fauna, as well as preferences for different nest-box designs. Implications. It is important to note that the criteria used for determining the presence or absence in the nest box (i.e. temperature difference, Tin– Tout, of 2°C) in the present study will not be relevant for all nest-box designs and before using these methods, the thermal properties of the nest box or tree hollow will require investigation. [ABSTRACT FROM AUTHOR]