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BACKGROUND: The effects of traffic sign information volume (TSIV) on the visual characteristics and workload of novice and experienced drivers were investigated in this study. TSIV plays a crucial role in road traffic safety, and understanding its impact on drivers is essential for designing effective traffic sign systems. OBJECTIVE: This research aimed to compare the visual characteristics and workload of novice and experienced drivers under varying TSIV doses through simulated driving tests. The objective was to provide insights for optimizing the design of road TSIV. METHODS: Six TSIV levels were considered: S0, S1, S2, S3, S4, and S5, representing different workload levels. Participants, including both novice and experienced drivers, were involved in simulated driving scenarios with varying TSIV levels. Eye movement data was collected using an eye tracker device. The study was conducted in China, and appropriate driving simulators and equipment were utilized. RESULTS: The findings revealed several valuable results. Experienced drivers exhibited a higher proportion of saccade behavior in the 30–90 ms time period and did not show rapid saccade behavior during the 0–30 ms period, indicating superior visual search strategies. Both novice and experienced drivers demonstrated improved visual cognitive abilities at the S3 level of TSIV, which corresponds to normal and safe driving conditions. Furthermore, a majority of both groups had saccade amplitudes in the range of 0°–4°, with experienced drivers showing a slightly higher proportion. About 82% of experienced drivers had saccade behavior within the range of 0°–2°, compared to 75% of novice drivers. CONCLUSIONS: The study concludes that the S3 level of TSIV, corresponding to 30 bits/km, is optimal for both novice and experienced drivers. This level promotes better visual performance and reduces visual workload, indicating that drivers' information acquisition capacity and visual search strategies are maximized while keeping the workload associated with driving at a minimum. These findings have significant implications for enhancing driving safety. [ABSTRACT FROM AUTHOR]

Background: Prediabetes is a high-risk state for diabetes, and numerous studies have shown that the body mass index (BMI) and triglyceride-glucose (TyG) index play significant roles in risk prediction for blood glucose metabolism. This study aims to evaluate the relative importance of BMI combination with TyG index (TyG-BMI) in predicting the recovery from prediabetic status to normal blood glucose levels. Methods: A total of 25,397 prediabetic subjects recruited from 32 regions across China. Normal fasting glucose (NFG), prediabetes, and diabetes were defined referring to the American Diabetes Association (ADA) criteria. After normalizing the independent variables, the impact of TyG-BMI on the recovery or progression of prediabetes was analyzed through the Cox regression models. Receiver Operating Characteristic (ROC) curve analysis was utilized to visualize and compare the predictive value of TyG-BMI and its constituent components in prediabetes recovery/progression. Results: During the average observation period of 2.96 years, 10,305 individuals (40.58%) remained in the prediabetic state, 11,278 individuals (44.41%) recovered to NFG, and 3,814 individuals (15.02%) progressed to diabetes. The results of multivariate Cox regression analysis demonstrated that TyG-BMI was negatively associated with recovery from prediabetes to NFG and positively associated with progression from prediabetes to diabetes. Further ROC analysis revealed that TyG-BMI had higher impact and predictive value in predicting prediabetes recovering to NFG or progressing to diabetes in comparison to the TyG index and BMI. Specifically, the TyG-BMI threshold for predicting prediabetes recovery was 214.68, while the threshold for predicting prediabetes progression was 220.27. Additionally, there were significant differences in the relationship of TyG-BMI with prediabetes recovering to NFG or progressing to diabetes within age subgroups. In summary, TyG-BMI is more suitable for assessing prediabetes recovery or progression in younger populations (< 45 years old). Conclusions: This study, for the first time, has revealed the significant impact and predictive value of the TyG index in combination with BMI on the recovery from prediabetic status to normal blood glucose levels. From the perspective of prediabetes intervention, maintaining TyG-BMI within the threshold of 214.68 holds crucial significance. [ABSTRACT FROM AUTHOR]

Highlights: 1. How to quantitative evaluation of mechanical properties of shale in Da'anzhai section combined with triaxial mechanical experiments? The compressive strength of dry rock samples and soaked rock samples were tested by triaxial mechanical experiments. According to the stress-strain curves, the changes of compressive strength, elastic modulus and Poisson's ratio before and after hydration were analyzed. 2. How to establish a mathematical model of shale fracability that comprehensively considers brittleness index, horizontal differential stress, and fracture toughness is proposed? Fracability index is proportional to brittleness index and horizontal differential stress, and inversely proportional to fracture toughness. Young 's modulus, Poisson's ratio and tensile strength in fracability index model are related to rock water saturation, so the fracturing index is also related to rock hydration. 3. What is the effect of shale hydration on fracability and fracture pressure? As the water saturation rate of the rock gradually decreases, the FI of the formation rock de-creases Combined with the variation law of water saturation rate, it shows that after the shale around the well is hydrated, the fracture pressure of the formation decreases Accurate evaluation of shale oil reservoir fracability helps avoid blind fracturing and ensures efficient fracturing. However, the current evaluation of the fracability index rarely considers the impact of hydration caused by drilling fluid invasion during drilling. The results of a rock triaxial mechanical test conducted to evaluate the mechanical properties of shale oil reservoirs are reported in this paper. Based on the results, we developed a comprehensive evaluation method of shale oil reservoir fracability that considers hydration; the effects of the brittleness index, horizontal difference stress, and fracture toughness; and the law of water phase intrusion into shale oil reservoirs. The research results show that the average compressive strength decreased by 37.99%, the average elastic modulus decreased by 53.36%, and the average Poisson's ratio increased by 68.75% after being soaked for 48.00 h at 80 °C and 30.00 MPa. The water saturation rate at the borehole wall was the highest; with the extension to the stratum, it gradually decreases to the original water saturation rate of the formation, while the fluctuation radius gradually increases with time. The Young's modulus and fracture toughness decrease, the Poisson's ratio increases, and the fracability index reaches a maximum value at the wellbore (i.e., the highest water saturation rate), indicating that the strength of the hydrated rock decreases and it can be easily fractured. The case analysis shows that the optimal fracturing position of the Da'anzhai Section of Well NC2H is around 2600 m deep. After the hydration occurs, the fracture initiation pressure of the formation is reduced from the original value of 72.31 MPa to 66.80 MPa. This indicates that when hydration decreases, the formation fracture pressure also increases. The research presented in this paper can be used to optimize fracture location and set a reasonable fracturing pressure. [ABSTRACT FROM AUTHOR]

The wellbore instability of the deep coal seam has always been a difficult problem limiting drilling engineering in Dibei area of Tarim basin, China. Therefore, the mechanisms of wellbore instability and anticollapse countermeasures in the Dibei deep coal seam are investigated in this study. Firstly, the microstructure and physical and chemical properties of coal and rock are studied to analyze instability mechanism. In addition, orthogonal cleat model and 3 Dimension Distinct Element Code (3DEC) model were proposed to calculate the collapse pressure of the coal seam. And we propose a method for optimizing well trajectory based on wellbore stability. Finally, by optimizing plugging material, an anti-collapse drilling fluid for coal seams is designed and applied in the field. The results indicate that there are many cleats and no montmorillonites in the clay minerals present in coal rocks, indicating that the deep coal seam in Dibei is mainly mechanically unstable. 3DEC model is more accurate, and the orthogonal cleat model can reflect the collapse pressure distribution more intuitively. The reliability of these two models is demonstrated by the actual drilling fluid density of the DB-X01. Furthermore, this study confirms that the blocking-material system of the wellbore stabilization strategy in a coal seam is 3% sulfonated asphalt, 3% emulsified asphalt, and 3% calcium carbonate based on microstructure characteristics. The results of rolling recovery rate and rheology experiments show that the new anti-collapse drilling fluid has better sealing and inhibiting properties on coal seams. Field testing in DT2 well demonstrated the reliability of the collapse pressure prediction model and anticollapse countermeasures proposed in this study. The findings of this study can help for better understanding of wellbore instability mechanism and countermeasures in coal seam. The study is useful for the safe and efficient development of the coal seams in the Dibei area. [ABSTRACT FROM AUTHOR]

The Daniudi gas field is typically rich in ultra-low permeability gas reservoirs in China, but its development is difficult. In this paper, pilot implementation of underbalanced horizontal well drilling technology was used in the H1 gas reservoir to develop the proved reserves effectively. Owing to the limitations of drilling technology and environmental protection, the recyclable nitrogen-foam was ultimately chosen as a circulating medium. Through theoretical analysis and extensive laboratory tests, the optimal foaming agent composed of α-olefin sulfonate and coco amine oxide was selected among six anionic surfactants/zwitterionic surfactants systems. The developed recyclable nitrogen-foam has high salt resistance, temperature resistance and cycle performance, but weaker oil resistance. After the recyclable nitrogen-foam horizontal well drilling technology was used in the H1 gas reservoir, the average rate of penetration of horizontal section increased by 118 %, ignition could be achieved during drilling and natural gas was of great potential for production. It was the first time to increase natural gas production capacity in the H1 gas reservoir using recyclable nitrogen-foam horizontal well drilling technology. Successful application of this technology provides technical reserves for the effective development of the H1 gas reservoir. [ABSTRACT FROM AUTHOR]

• The tunnel entrance zone has a short length and the driving environment in this section undergoes abrupt transitions, leading to complex driving behaviors. For instance, abrupt and significant decelerations can occur, which intensify the potential for longitudinal interference with following vehicles. Moreover, the centerline of the trajectory may deviate from the lane center, increasing the lateral interference with vehicles in the adjacent lanes. • To accurately describe the complex driving behaviors in this short section, a series of novel indicators (TPav, N|DS, G|VT, and SWAav) were derived based on the driving behavior patterns observed in this section. The TPav and N|DS indicators quantify the smoothness of deceleration, while the G|VT and SWAav indicators reflect the gradualness and stability of the trajectory. • A visual guidance system tailored to the specific needs of drivers in the tunnel entrance zone was developed. • Quantitatively evaluate the effectiveness of (i) visual guidance devices at different vertical positions (pavement and roadside) and (ii) a multilayer visual guidance system for regulating driving behavior in the tunnel entrance zone. In China, visual guidance systems are commonly used in tunnels to optimize the visual reference system. However, studies focusing specifically on visual guidance systems in the tunnel entrance zone are limited. Hence, a driving simulation test is performed in this study to quantitatively evaluate the effectiveness of (i) visual guidance devices at different vertical positions (pavement and roadside) and (ii) a multilayer visual guidance system for regulating driving behavior in the tunnel entrance zone. Furthermore, the characteristics of driving behavior and their effects on traffic safety in the tunnel entrance zone are examined. Data such as the vehicle position, area of interest (AOI), throttle position, steering wheel angle, and lane center offset are obtained using a driving simulation platform and an eye-tracking device. As indicators, the first fixation position (FP), starting deceleration position (DP), average throttle position (TPav), number of deceleration stages (N|DS), gradual change degree of the vehicle trajectory (G|VT), and average steering wheel angle (SWAav) are derived. The regulatory effect of visual guidance devices on driving performance is investigated. First, high-position roadside visual guidance devices effectively reduce decision urgency and significantly enhance deceleration and lane-keeping performance. Specifically, the advanced deceleration performance (AD), smooth deceleration performance (SD), trajectory gradualness (TG), and trajectory stability (TS) in the tunnel entrance zone improve by 63%, 225%, 269%, and 244%, respectively. Additionally, the roadside low-position visual guidance devices primarily target the trajectory gradualness (TG), thus resulting in improvements by 80% and 448% in the TG and TS, respectively. Meanwhile, the pavement visual guidance devices focus solely on enhancing the TS and demonstrates a relatively lower improvement rate of 99%. Finally, the synergistic effect of these visual guidance devices facilitates the multilayer visual guidance system in enhancing the deceleration and lane-keeping performance. This aids drivers in early detection and deceleration at the tunnel entrance zone, reduces the urgency of deceleration decisions, promotes smoother deceleration, and improves the gradualness and stability of trajectories. [ABSTRACT FROM AUTHOR]

Objective: The deterioration of acute decompensated heart failure (ADHF) is associated with abnormal activation of inflammatory pathways. This study aims to evaluate the impact and predictive value of a novel inflammatory marker, the systemic inflammation response index (SIRI), on short-term adverse outcomes in ADHF patients., Methods: This retrospective cohort study included 1,448 ADHF patients from Jiangxi Provincial People's Hospital between 2019-2022. SIRI was calculated using the formula: (neutrophil count × monocyte count)/lymphocyte count. In the correlation analysis, the study outcome was the 30-day mortality in patients with ADHF. Cox regression analysis and receiver operating characteristic curves were employed to investigate the risk assessment and predictive value of the SIRI for 30-day mortality in ADHF patients. Finally, we also exploratively assessed the mediation effect of nutritional factors (albumin: Alb, total cholesterol: TC, and lymphocyte count) on the association between SIRI and 30-day mortality in ADHF patients., Results: During the 30-day follow-up, 53 deaths were recorded. Mortality rates across SIRI tertiles were 0.62%, 2.07%, and 8.28%, respectively. There was a significant linear positive correlation between SIRI and 30-day mortality in ADHF patients (HR: 1.21; P for non-linearity = 0.113). Additionally, compared to ADHF patients with low SIRI, those with high SIRI had a 685% increased risk of 30-day mortality (HR: 7.85). Furthermore, receiver operating characteristic curve analysis demonstrated that SIRI significantly improved the predictive value for 30-day mortality in ADHF patients compared to neutrophil count, monocyte count, and lymphocyte count alone (AUC: neutrophil count 0.7633, monocyte count 0.6835, lymphocyte count 0.7356, SIRI 0.8237; all DeLong P <0.05). Mediation analyses indicated that, except for lymphocyte count, both Alb and TC had significant indirect effects on the SIRI-related 30-day mortality in ADHF patients; Specifically, Alb accounted for approximately 24.46% of the mediation effect, while TC accounted for approximately 13.35%., Conclusion: This cohort study based on a Southern Chinese population demonstrates a significant linear positive correlation between SIRI and 30-day mortality in ADHF patients, highlighting its substantial predictive value. Incorporating SIRI into the monitoring regimen of ADHF patients may be crucial for preventing further disease progression., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Xie, Wang, Lu, Kuang, He, Xie, Sheng, Zhang, Wang and Zou.)

Aims: The value of the systemic immune-inflammatory index (SII) in assessing adverse outcomes in various cardiovascular diseases has been extensively discussed. This study aims to evaluate the predictive value and risk stratification ability of SII for 30 day mortality in patients with acute decompensated heart failure (ADHF)., Methods: This analysis included 1452 patients hospitalized for ADHF, all the participants being part of the China Jiangxi-acute decompensated heart failure1 project. The risk stratification capability of the SII in patients with ADHF, as well as its correlation with the 30 day mortality risk among ADHF patients, was evaluated utilizing Kaplan-Meier survival analysis and multivariable Cox regression models. A restricted cubic spline was employed to model the dose-response relationship between the two, and the receiver operating characteristic curve was utilized to assess the predictive ability of SII for 30 day mortality., Results: The Kaplan-Meier analysis revealed that the risk of mortality in the high SII group (SII ≥ 980 × 10 9 /L) was significantly greater than that in the low SII group (SII < 980 × 10 9 /L, log-rank P < 0.001). After adjusting for various confounding factors, a higher SII was associated with an increased risk of 30 day mortality in ADHF patients [hazard ratio (HR) = 2.03, 95% confidence interval (CI): 1.34-3.08]. Further restricted cubic spline analysis revealed a non-linear dose-response relationship between the two (P for non-linear = 0.006). Receiver operating characteristic analysis demonstrated that SII had a high accuracy in predicting 30 day mortality events in ADHF patients (AUC = 0.7479), and the optimal predictive threshold was calculated to be 980 × 10 9 /L, a sensitivity of 0.7547 and a specificity of 0.7234., Conclusions: This study found a significant positive association between SII and 30 day all-cause mortality in ADHF patients. We determined the SII cut-off point for predicting 30 day all-cause mortality in patients with ADHF to be 980 × 10 9 /L., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Objectives: This research aims to: (i) compare the effects of different sidewall entrainment facilities on drivers' visual behavior; (ii) compare the effects of the same sight entrainment facilities on drivers in different lanes; (iii) give recommendations for engineering applications based on the results of the study., Methods: The study designed four different scenes, each with symmetrically designed visual facilities on the both sidewalls of the tunnel, scene a represents a typical urban tunnel in China (horizontal stripes on sidewalls), scene b includes vertical stripes on sidewalls in addition to scene a, scene c introduces an LED-arch based on scene b, and scene d features a rhythmic pattern (Wave pattern on sidewalls). 30 participants, 21 men and 9 women, aged 21-54, drove the four scenes. Eye movement data of participants in each lane for different scenes were collected using an eye-tracking device. Visual performance indicators including fixation duration, number of fixations, saccade duration, and saccade amplitude were utilized to comprehensively evaluate drivers' visual behavior. Factor analysis was employed to analyze the impact of different visual guiding facilities on drivers' visual searching abilities., Results: There is a significant effect of sidewall guiding facilities and lane location on drivers' visual behavior and loading. Across scenes, drivers' visual load is ranked as follows, from highest to lowest: scene a (baseline) > scene b (horizontal stripes added to scene a) > scene c (LED-arch added to scene b) > scene d (Wave pattern). Furthermore, under the same scene, drivers' visual load in each lane is ranked in descending order: Middle lane > Right lane > Left lane., Conclusion: Due to the effect of the tunnel structure on the drivers' visual field, drivers in the left lane have the highest visual load in any scenario compared to the other two lanes, which can be ameliorated but not eliminated. Traditional guiding facilities and decorated pattern both improve the visual behavior and reduce drivers' visual load in urban tunnels, especially in scene c and scene d, but scene d should not be used for the entire length of the tunnel in order to prevent driver distraction. In engineering practice, scene c (LED-arch added to scene b) can be set up in general sections of urban tunnels, and decorated pattern can be added to fatigue reminder regions to alleviate driving fatigue.

Objective: Both alanine aminotransferase (ALT) and high-density lipoprotein cholesterol (HDL-C) are closely related to glucose homeostasis in the body, and the main objective of this study was to investigate the association between ALT to HDL-C ratio (ALT/HDL-C ratio) and the risk of diabetes in a Chinese population., Methods: The current study included 116,251 participants who underwent a healthy physical examination, and the study endpoint was defined as a diagnosis of new-onset diabetes. Multivariate Cox regression models and receiver operator characteristic curves were used to assess the association of the ALT/HDL-C ratio with diabetes onset., Results: During the average observation period of 3.10 years, a total of 2,674 (2.3%) participants were diagnosed with new-onset diabetes, including 1,883 (1.62%) males and 791 (0.68%) females. After fully adjusting for confounding factors, we found a significant positive association between the ALT/HDL-C ratio and the risk of diabetes [Hazard ratios 1.06, 95% confidence intervals: 1.05, 1.06], and this association was significantly higher in males, obese individuals [body mass index ≥ 28 kg/m 2 ] and individuals aged < 60 years (All P interaction < 0.05). In addition, the ALT/HDL-C ratio was significantly better than its components ALT and HDL-C in predicting diabetes in the Chinese population., Conclusion: There was a positive relationship between ALT/HDL-C ratio and diabetes risk in the Chinese population, and this relationship was significantly stronger in males, obese individuals, and individuals younger than 60 years old., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 He, Yu, Kuang, Qiu, Yang, Zhang, Sheng and Zou.)

Background: A cross-sectional association between the combination indicator of high-density lipoprotein cholesterol (HDL-C) and gamma-glutamyl transferase (GGT) and fatty liver has been described in several recent studies, and this study aims to further evaluate the longitudinal relationship between the ratio of GGT to HDL-C (GGT/HDL-C ratio) and nonalcoholic fatty liver disease (NAFLD)., Methods: This cohort study included 12,126 individuals without NAFLD at baseline, followed prospectively for 5 years, and the endpoint of interest was new-onset NAFLD. The relationship of the GGT/HDL-C ratio with new-onset NAFLD and the shape of the association was assessed by Cox regression models and restricted cubic spline (RCS) regression, respectively. Time-dependent receiver operator characteristics (ROC) curves were constructed to evaluate the predictive value of GGT, HDL-C, GGT/HDL-C ratio and BMI for the occurrence of NAFLD at different time points in the future., Results: The prevalence of NAFLD was 72.46/1000 person-years during the 5-year follow-up period. Results of multivariate Cox regression analysis showed a positive association of the GGT/HDL-C ratio with new-onset NAFLD after adequate adjustment of the related confounding factors, and the degree of correlation was slightly higher than that of GGT, and further subgroup analysis found that this association was more significant in the population with elevated systolic blood pressure (SBP). In addition, we also found a nonlinear relationship of the GGT/HDL-C ratio with the risk of new-onset NAFLD using the RCS regression, where the saturation threshold was about 31.79 U/mmol. Time-dependent ROC analysis results showed that the GGT/HDL-C ratio was increasingly valuable in predicting NAFLD over time, and was better than HDL-C in predicting NAFLD in the early stage (1-3 years), but was not superior to BMI and GGT., Conclusions: In this large longitudinal cohort study based on a Chinese population, our results supported that the GGT/HDL-C ratio was positively and nonlinearly associated with the risk of new-onset NAFLD in a non-obese population. In the assessment of future NAFLD risk, the GGT/HDL-C ratio was slightly better than GGT alone; However, the GGT/HDL-C ratio did not appear to have a significant advantage over GGT and BMI alone in predicting NAFLD., (© 2022. The Author(s).)

Abstract: Patient feedback can provide insights to assess and improve the quality of healthcare. This study aimed to develop a measure of surgical inpatient satisfaction and comfort and examine its acceptability, validity, and reliability among discharged surgical patients.This multicenter, descriptive, cross-sectional study was conducted at three tertiary hospitals in Shaanxi Province, China. A random sample of patients admitted to the surgical inpatient departments of the three hospitals between November and December 2018 was recruited. An analysis was conducted on the acceptability, validity, and reliability of a newly developed measure of satisfaction with surgical inpatient services.A total of 1582 out of 1805 (87.6%) eligible patients completed the questionnaire (average time taken = 17.1 ± 10.3 minutes), which indicated high acceptability. Sociodemographic differences between the participants and non-participants were not significant. Using factor analysis, the following 7 dimensions (number of items: 65, variance explained: 68.0%) were identified: medical care (19 items), nursing care (15 items), environment and logistics (11 items), postoperative and hospitalization experiences (11 items), feeling nervous and afraid (4 items), operating room services (3 items), and visiting (2 items). The latent structure of the assessment was examined and validated using exploratory and confirmatory factor analyses, respectively. All item loadings were >0.4. All dimensions demonstrated satisfactory internal consistency (Cronbach's alphas = 0.83-0.96) and test-retest reliability (intra-class correlation coefficients = 0.77-0.96).The Chinese Surgical Inpatient Satisfaction and Comfort Questionnaire has strong psychometric properties and can be used to assess patient satisfaction with public hospital surgical inpatient services in China. A distinguishing feature of this questionnaire is the inclusion of a subscale that assesses comfort as a dimension of patient satisfaction. Such instruments can be used to identify the factors that should be addressed to improve the quality of patient care. Further research is needed to determine the role of assessment in quality improvement., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Endoscopic endonasal transsphenoidal resection has been accepted as a routine therapy for pituitary adenoma, but the postoperative hospital stay is typically several days long. With the advantages of reduced cost and improved patient satisfaction, the application of ambulatory surgery (AS) has developed rapidly. However, AS was still rarely adopted in neurosurgery. Here we designed an AS treatment protocol for pituitary adenoma with the endoscopic endonasal approach (EEA), and reported our initial experiences regarding the safety and efficacy of the AS protocol. 63 patients who presented with pituitary adenoma were screened at the Department of Neurosurgery, Tangdu Hospital from July to September, 2017. A total of 20 pituitary adenoma patients who met the inclusion criteria underwent EEA surgery using this evidence-based AS protocol, which emphasized adequate assessment for eligibility, full preparation to minimize invasiveness, enhanced recovery, and active perioperative patient education. Of the 20 patients enrolled, 18 were discharged on the afternoon of the operation day with a median total length of stay (LOS) of 31 hours (range, 29-32) hours. The median LOS after surgery was 6.5 (range, 5-8) hours. Two patients were transferred from the AS protocol to conventional care due to intraoperative cerebrospinal fluid leakage (one case) and an unsatisfying post-anesthetic discharge score (one case). Complications included transient and reversible mild postoperative nausea and vomiting [visual analog scale (VAS) score <3], headache (VAS score <3) after the operation or early after discharge. No patient was readmitted. Our results supported the safety and efficacy of the AS protocol for pituitary adenoma patients undergoing EEA resection among eligible patients, and further evaluation of this protocol in controlled studies with a larger sample size is warranted.

Objective: To evaluate patient satisfaction and associated predictors at discharge, as well as patient experience at 30-day follow-up, in a neurosurgical enhanced recovery after surgery (ERAS) programme., Design: A single-centre, prospective, randomised controlled study., Setting: A tertiary hospital in China., Participants: A total of 140 neurosurgical patients aged 18-65 years old who had a single intracranial lesion and were admitted for elective craniotomy between October 2016 and July 2017 were included., Interventions: Patients were randomised into two groups: 70 patients received care according to a novel neurosurgical ERAS protocol (ERAS group) and 70 patients received conventional perioperative care (control group)., Outcome Measures: Patient satisfaction at discharge was evaluated using a multimodal questionnaire. A secondary analysis of patient experience regarding participation in the ERAS programme was conducted using a semistructured qualitative interview via telephone at 30-day follow-up., Results: The mean patient satisfaction was significantly higher in the ERAS group than in the control group at discharge (92.2±4.3 vs 86.8±7.4, p=0.0001). The most important predictors of patient satisfaction included age (OR=6.934), postoperative nausea and vomiting (PONV) Visual Analogue Scale (VAS) score (OR=0.184), absorbable skin suture (OR=0.007) and postoperative length of stay (LOS) (OR=0.765). Analysis on patient experience revealed five themes: information transfer, professional support, shared responsibility and active participation, readiness for discharge, and follow-up, all of which are closely related and represent positive and negative aspects., Conclusions: Measures that include decreasing PONV VAS score, incorporating absorbable skin suture and shortening LOS seem to increase patient satisfaction in a neurosurgical ERAS programme. Analysis of data on patient experience highlights several aspects to achieve patient-centred and high-quality care. Further studies are warranted to standardise the assessment of patient satisfaction and experience in planning, employing and appraising the ERAS programme., Trial Registration Number: ChiCTR-INR-16009662., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)